ABSTRACT
OBJECTIVE: To evaluate whether clinical features associated with head injury in children can be correlated with an abnormal computed tomography (CT) scan. METHODOLOGY: Three hundred and eleven children aged 14 years or younger admitted with a diagnosis of acute head injury were studied retrospectively. RESULTS: A Glasgow Coma Scale (GCS) score of 12 or lower and the presence of focal neurological deficits were significant predictors of an abnormal CT scan. Ninety-five per cent of those with abnormal CT scans and 100% of those with intracranial injury could be identified by the presence of one or more of the nine clinical findings, particularly by a GCS score of 12 or lower, and the presence of focal neurological deficits. Identification was also possible to a lesser degree by loss of consciousness, ataxia, amnesia, drowsiness, headache, seizure or vomiting. CONCLUSION: Use of CT scans can be limited to children with ongoing specific symptoms and/or focal neurological signs. The implementation of guidelines in the management of head injuries in children could have a substantial effect on clinical practice and health-care costs.
Subject(s)
Craniocerebral Trauma/diagnostic imaging , Craniocerebral Trauma/diagnosis , Patient Selection , Tomography, X-Ray Computed , Adolescent , Child , Child, Preschool , Craniocerebral Trauma/etiology , Female , Glasgow Coma Scale , Humans , Infant , Infant, Newborn , Male , Neurologic Examination , Physical Examination , Predictive Value of Tests , Retrospective Studies , TasmaniaSubject(s)
Abscess/complications , Esophageal Diseases/complications , Esophagus/injuries , Foreign Bodies/complications , Respiratory Sounds/etiology , Tracheal Stenosis/complications , Abscess/diagnosis , Abscess/surgery , Bronchography , Bronchoscopy , Esophageal Diseases/diagnosis , Esophageal Diseases/surgery , Esophagus/diagnostic imaging , Esophagus/surgery , Fiber Optic Technology , Foreign Bodies/diagnosis , Foreign Bodies/surgery , Humans , Infant , Male , Mediastinum , Radiography, Thoracic , Respiratory Sounds/diagnosis , Rupture , Tomography, X-Ray Computed , Tracheal Stenosis/diagnosis , Tracheal Stenosis/surgeryABSTRACT
Three children with cystic fibrosis (CF) had significant pulmonary haemorrhage during anaesthetic induction prior to bronchial artery embolization (BAE). Haemorrhage was associated with rapid clinical deterioration and subsequent early death. We believe that the stresses associated with intermittent positive pressure ventilation (IPPV) were the most likely precipitant to rebleeding and that the inability to clear blood through coughing was also an important factor leading to deterioration. Intermittent positive pressure ventilation should be avoided when possible in children with CF with recent significant pulmonary haemorrhage.
Subject(s)
Anesthesia, General , Bronchial Arteries , Cystic Fibrosis/therapy , Embolization, Therapeutic , Hemoptysis/etiology , Intraoperative Complications , Adolescent , Anesthesia, General/adverse effects , Child , Cough/physiopathology , Cystic Fibrosis/complications , Embolization, Therapeutic/adverse effects , Fatal Outcome , Female , Hemoptysis/physiopathology , Humans , Intermittent Positive-Pressure Ventilation/adverse effects , Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/instrumentation , Male , Positive-Pressure Respiration/adverse effects , Recurrence , Respiratory Insufficiency/etiologyABSTRACT
While inhaled steroids (IS) are increasingly recognized as having a more rapid onset of action than was once thought, little is known about the early changes in objective measures of respiratory function that follow the inhalation of repeated doses. These early effects were examined in a randomized, double-blind, placebo-controlled, crossover study of 20 children aged 10-16 years with stable mild asthma. Beclomethasone dipropionate (BDP) 2,000 mcg, fluticasone propionate (FP) 400 mcg, and placebo were given twice daily for three doses. Airway hyperreactivity (AHR) to methacholine (PC20), pulmonary function tests (PFT: FVC, FEV1, FEF25-75%), and the rate of recovery from methacholine-induced bronchospasm following administration of salbutamol were determined at 8 h (after 1 dose) and at 32 h (after three doses). At 8 h, minor improvements in AHR were demonstrated, averaging 0.32 doubling doses in PC20. At 32 h, significant improvements in AHR and PFTs were present, averaging 0.92 doubling doses in PC20, 3.96% of predicted values in FEV1, and 7.74% of predicted values in FEF25-75%. No significant changes occurred in FVC. There were no significant differences between the effects of BDP and FP. Inhaled steroids were associated with a slower response to salbutamol following methacholine challenge testing at 32 h. We conclude that IS, given in repeated high doses, result in significant improvements within 32 h in both AHR and PFTs, along with changes in response to beta2 agonists. These effects are likely to be the result of the topical activity of IS.
Subject(s)
Androstadienes/pharmacology , Anti-Asthmatic Agents/pharmacology , Asthma/physiopathology , Beclomethasone/pharmacology , Bronchial Hyperreactivity/drug therapy , Glucocorticoids/pharmacology , Respiratory Mechanics/drug effects , Administration, Inhalation , Adolescent , Androstadienes/administration & dosage , Androstadienes/therapeutic use , Anti-Asthmatic Agents/administration & dosage , Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , Beclomethasone/administration & dosage , Beclomethasone/therapeutic use , Bronchial Hyperreactivity/physiopathology , Bronchial Provocation Tests , Child , Cross-Over Studies , Double-Blind Method , Female , Fluticasone , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Male , Respiratory Function Tests , Treatment OutcomeABSTRACT
OBJECTIVES: To describe experience with subglottic haemangioma in a unit where conservative treatment has been favoured. METHODS: Retrospective case note review of infants presenting with subglottic haemangioma over a 25 year period. RESULTS: Thirty one infants were identified. Diagnosis was difficult where skin haemangiomas were absent and where the lesion was circumferential rather than asymmetrical. Tracheostomy was safe, well tolerated, and managed by the patients' family at home. Major complications were seen only when laser treatment was used. CONCLUSIONS: Aggressive treatment with substantial risks of long term complications may not be necessary in this spontaneously resolving disorder.
