Multiple injuries in vital organs in a child from a gunshot: a case report.

INTRODUCTION: Many people in rural and urban areas own a gun legally or illegally. It is a social phenomenon that apart from the adults, the children become familiar with the guns in early age. CASE PRESENTATION: A nine year old boy was shot by accident by his uncle, who was cleaning his gun (carbine) close to where the child was playing. More than 200 pellets were counted in the boy's x-rays. The boy was hospitalised in pediatric intensive care unit with many injuries in thorax, abdomen, and limbs, clearly shown by the x-rays. He developed multiple injuries in lungs and liver, bilateral haemothorax and pneumothorax, subcutaneous emphysema, injury of pericardium, perirenal hematoma, choloperitoneum, injuries in the intestine and in the limbs. Initial level of lead in the boy's body was measured as a reference value. Thereafter, frequent monitoring for lead levels was scheduled to prevent a potential lead poisoning from the pellets' absorption. After the appropriate treatment the boy left the hospital in a month in good health. CONCLUSION: The consequences from gun use in places where children are exposed could be fatal. The appropriate co-operation of different medical sub-specialities in Pediatrics and the presence of pediatric intensive care unit can save the life of a child with multiple injuries.

Prognostic value of quantitative blood cultures for the outcome of central venous catheters in children.

Quantitative blood cultures have been used in order to define catheter-related bloodstream infection (CRBI) in pediatric patients with malignancy and central venous catheters (CVCs). We prospectively followed 32 patients with a total of 38 CVCs for a period of 4 y (14,068 catheter-days). Of a total of 35 cases of bacteremia, 9 were considered to be CRBI (25%). The incidence of bacteremia in our study was 2.48 episodes/1,000 catheter-days and 20/38 CVCs (52%) were affected by bacteremia. The incidence of CRBI was 0.63 episodes/1,000 catheter-days and it was detected in 9/38 CVCs (23%). The catheter salvage rate in cases of bacteremia, irrespective of etiology, was 30/35 (85%). The catheter salvage rate in cases of CRBI was only 4/9 (44%), whereas all the catheters (26/26) in non-catheter-related cases of bacteremia were salvaged. We suggest that the use of quantitative blood cultures is a useful tool for the evaluation of bacteremia in patients with CVCs and is of prognostic value.

Prophylaxis with urokinase in pediatric oncology patients with central venous catheters.

This study evaluated the effects of urokinase in the prevention of central venous catheter (CVC)-related complications in children with malignancy. Fifteen patients with 16 CVCs (study group A) received an intraluminal application of urokinase (10,000 IU in each catheter lumen for 4 h) once a week. They were monitored prospectively with quantitative blood cultures and ultrasonography (color Doppler ultrasound of the great veins and echocardiography). The rate of complications was compared with that of 15 children with 19 CVCs without thromboprophylaxis, treated the previous significantly lower incidence of CVC dysfunction year (control group B). The authors found a wer incidence of CVC dysfunction (3/16 versus 13/19), no major thrombosis, fewer CVC-related bacteremias (2/16 versus 8/19), and a higher salvage of CVCs (1/16 versus 5/19 CVC removals due to persistent bacteremia) in the thromboprophylaxis group. Asymptomatic thrombosis rate was also lower (7/16 cases in group A versus 9/11 in group B when sonography was performed). No hemorrhagic complications were noted. Thromboprophylaxis with urokinase seems a safe and effective measure for reducing the rate of CVC-related complications.