ABSTRACT
Introduction: A Morel-Lavallée lesion (MLL) is a closed degloving injury secondary to shearing forces. MLL is a rare, easily overlooked diagnosis, especially in those without recent trauma or fracture. Patients will present with ecchymosis, edema, fluctuance, and skin hypermobility or tightness. We present a case of pediatric MLL that was initially challenging to diagnose as the inciting trauma was 2 months before her diagnosis. Case Report: A 14-year-old girl presented with 5 days of left leg bruising, swelling, and pain. Two months prior, she collided with another softball player's cleat and developed a hairline fracture. Magnetic resonance imaging of the left lower extremity (LLE) showed a closed, soft-tissue degloving injury, and she was diagnosed with a MLL. Throughout her admission, she had improvement in her bruising but continued to have pain with ambulation that was somewhat alleviated with the use of a compression stocking. Pediatric Orthopedic Surgery and Interventional Radiology were consulted, and a conservative approach was recommended with 3 months of LLE compression. Conclusion: MLL typically occurs in patients in their 30-40s and rarely occurs in children. Identifying MLL in children is essential as children are more susceptible to shock and multi-organ damage from blunt trauma than adults. They are also more vulnerable to fractures and deep organ injuries. In the setting of MLL, children can quickly develop hypovolemic shock due to lower blood volumes and necrosis secondary to mass effect in the dead space. MLL should be included on the differential for children with trauma or a history of a shearing injury.
ABSTRACT
Renal toxicity has been described with tramadol overdoses; however, it is typically associated with rhabdomyolysis, multiorgan failure and/or mortality. Our patient was a 16-year-old female who was evaluated following an intentional tramadol ingestion, estimated 27.8 to 37 mg/kg, and had a seizure prior to arriving at our health care facility. Her symptoms were consistent with a tramadol ingestion; however, she developed transient acute renal impairment (peak serum creatinine, 4.04 mg/dL), which improved over 6 days with minimal intervention. No other causes were identified to explain her acute renal impairment thus it was attributed to the tramadol overdose. Providers should be aware that transient acute renal impairment could occur with an intentional tramadol ingestion and may not require aggressive intervention.
ABSTRACT
BACKGROUND: Although an association between adolescent sleep and substance use is supported by the literature, few studies have characterized the longitudinal relationship between early adolescent sleep and subsequent substance use. The current study examined the prospective association between the duration and quality of sleep at age 11 and alcohol and cannabis use throughout adolescence. METHODS: The present study, drawn from a cohort of 310 boys taking part in a longitudinal study in Western Pennsylvania, includes 186 boys whose mothers completed the Child Sleep Questionnaire; sleep duration and quality at age 11 were calculated based on these reports. At ages 20 and 22, participants were interviewed regarding lifetime alcohol and cannabis use. Cox proportional hazard analysis was used to determine the association between sleep and substance use. RESULTS: After accounting for race, socioeconomic status, neighborhood danger, active distraction, internalizing problems, and externalizing problems, both the duration and quality of sleep at age 11 were associated with multiple earlier substance use outcomes. Specifically, less sleep was associated with earlier use, intoxication, and repeated use of both alcohol and cannabis. Lower sleep quality was associated with earlier alcohol use, intoxication, and repeated use. Additionally, lower sleep quality was associated with earlier cannabis intoxication and repeated use, but not first use. CONCLUSIONS: Both sleep duration and sleep quality in early adolescence may have implications for the development of alcohol and cannabis use throughout adolescence. Further studies to understand the mechanisms linking sleep and substance use are warranted.
