ABSTRACT
Forty-seven children, ages 1 to 14 years, with appendicular peritonitis were randomly divided into two groups: 27 were treated with the combination tobramycin-clindamycin and 20 with cephalothin followed by cephalexin. The overall rate of complications was 32%. Patients who had had their symptoms for less than 48 hours before being admitted to hospital had significantly fewer complications than those whose symptoms had lasted longer. Patients treated with tobramycin-clindamycin had significantly fewer wound infections. As clindamycin is effective against anaerobes this observation supports the view that anaerobes play an important role in the infectious complications in peritonitis. In this series, 12 species of aerobes and eight species of anaerobes were cultured from peritoneal fluid. In eight patients only one species was isolated; in the remaining 39 patients 29 different combinations of bacteria were encountered. Early diagnosis and administration of antibiotics preoperatively or during surgery, including clindamycin, metronidazol or tinidazol is recommended in the treatment of children with appendicular peritonitis.
Subject(s)
Appendicitis/complications , Peritonitis/drug therapy , Adolescent , Aerobiosis , Anaerobiosis , Ascitic Fluid/microbiology , Bacteria/isolation & purification , Cephalexin/therapeutic use , Cephalothin/therapeutic use , Child , Child, Preschool , Clindamycin/therapeutic use , Drug Therapy, Combination , Female , Humans , Infant , Intestinal Perforation/complications , Male , Peritonitis/etiology , Tobramycin/therapeutic useABSTRACT
The treatment series comprised 96 children with flexor tendon injuries of the hand. Sixty-one per cent of the injuries were in no-man's land. About one half of the patients had tendon severances of the little or ring fingers. The flexor tendon was sutured in 57 hands (59%) and grafted in 37 hands (39%). Tendon transposition was performed in two hands (2%). A total of 84 children were reexamined after a mean follow-up of 8.5 years. Of 53 hands in which direct tendon sutures had been done, either as a primary, delayed or late procedure, results were good in 46 (86.8%), fair in five (9.4%) and poor in two (3.8%). Of 30 free tendon grafts performed on 29 patients, results were good in 14 fingers (46.7%), fair in 10 (33.3%) and poor in six (20%). We recommend primary suture of a divided profundus tendon at any level. A cut superficialis tendon in no-man's land should be excised, if the surgeon is not a skilled hand surgeon. In our experience suture of the flexor tendon, performed at any level, gives better results than grafting.
Subject(s)
Hand Injuries/surgery , Tendon Injuries/surgery , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Prognosis , Tendon Transfer , Tendons/transplantation , Transplantation, AutologousABSTRACT
Thirty-eight children in whom a peripheral nerve injury of the hand had been repaired from 2 to 18 years earlier (mean 7.5 years) were examined. All repairs had been performed with the conventional technique with epineural sutures, and nearly all were primary neurorrhaphies. Sensory recovery was evaluated by using the two-point discrimination test (2 PD). The results were considered good if the 2 PD value was less than 6 mm and poor if this value was more than 15 mm. Of the 20 repairs of an ulnar or median nerve, or both, results were good in eight (40%), fair in 10 (50%) and poor in two (10%). Of the 18 digital nerve repairs, results were good in 14 (77.8%) and fair in four. The results in this series are better than results reported for adults series.
Subject(s)
Hand Injuries/surgery , Peripheral Nerve Injuries , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Nerve Regeneration , Peripheral Nerves/surgery , PrognosisABSTRACT
A case of bursitis calcarea trochanterica acuta is reported in a boy aged four months. The calcification was amorphous, and arthrography revealed extension into the hip joint. The lesion was treated surgically.
Subject(s)
Bursitis/diagnostic imaging , Calcinosis/diagnostic imaging , Femur/diagnostic imaging , Hip Joint/diagnostic imaging , Acute Disease , Humans , Infant , Male , RadiographyABSTRACT
A series of 43 radial neck or head fractures in children was analysed with respect to the type of fracture and whether conservative or surgical treatment had been employed. Thirty-seven patients were examined after a follow-up period of 1-18 years (average 8 years). Tilting of the radial head, the length of the radius and the size of the radial head were measured roentgenologically to evaluate any growth disturbances. The results were good in 24, fair in 10 and poor in 3 cases. In the 14 patients treated surgically results were good in five, fair in six and poor in three cases. All but two of these patients had an angulation of the radial head of 30 degrees or more. The result was good in 20 of the 23 patients who were treated conservatively because the angulation was less than 30 degrees after reduction. In fair and poor cases the function was impaired by the limitation of motion. Disturbances in growth were generally slight, but an enlargement of the radial head was observed in 16 cases at the follow-up.
Subject(s)
Radius Fractures , Adolescent , Adult , Casts, Surgical , Child , Female , Follow-Up Studies , Fracture Fixation, Internal , Humans , Male , Radius Fractures/surgery , Radius Fractures/therapyABSTRACT
Traumatic bowing of the forearm or lower leg is reported in 31 children. It is a relatively rare condition. Bowing occurs most frequently in combination with fracture of the other bone in the same extremity. In a minority of cases a bowing deformity is a single lesion. Age distribution, degree of deformity, mechanism of origin and therapy are presented and discussed.
