Christmas surprise: the unnoticed journey of a needle-from bronchus to intestine.

We report on a 14-year-old Arabian girl who suddenly developed coughing after having aspirated a needle used for fixing her headscarf. The chest X-ray showed the needle located in the right main bronchus. However, subsequent flexible bronchoscopy could not detect any foreign body. A further X-ray of the abdomen showed the needle now behind the diaphragm. Gastro-oesophageal endoscopy was also uneventful. On the third day, the needle was excreted naturally. Astonishingly, this journey of the wandering needle from bronchus to intestine was not realised by the patient at any time. Our case highlights that children and adolescents should be warned repeatedly about the risks of putting needles between their teeth. It also reminds the physician to diagnose aspirated foreign bodies as early as possible to prevent wandering and migrating, which may induce new risks and unnecessary diagnostic and therapeutic procedures.

[Sonographic diagnosis of supracondylar fractures of the humerus]. / Sonographische Beurteilung von supracondylären Humerusfrakturen - Retrospektive und prospektive Untersuchungen bei Kindern -

AIM: The aim of this study is to evaluate whether sonography as a primary diagnostic tool can be used for the diagnosis of supracondylar fractures of the humerus within a screening regimen. METHOD: With standardized sonography, a total of 75 children with suspected fractures of the distal humerus were investigated. The initially retrospective study (learning phase) was followed by a prospective study. All examinations were counter-checked by radiography. Supplementary to the standard sections two new sectional planes had to be added and evaluated. RESULTS: Of 65 children with fractures of the elbow, 43 had supracondylar fractures. All fractures could be visualized sonographically in the retrospective study and were diagnosed in the prospective examination. No supracondylar fracture was overlooked. Five results were falsely positive and would have been classified as undislocated supracondylar fractures type Baumann I. With the introduction of the two new sectional planes (dorsal radial and dorsal ulnar longitudinal section), rotatory deformity could be assessed. CONCLUSION: The longitudinal sections of the first compartment (standard sections) together with the two newly added dorsal radial and ulnar sections improved the diagnosis of supracondylar fractures of the humerus. The primarily unsatisfactory results could be improved by introduction of these additional sections, which are now recommended as standard sections of ultrasound application. Having acquired sufficient experience, the method can be used as a screening method for primary diagnosis and documentation of supracondylar fractures.

[Pro and contra laparoscopic appendectomy in childhood]. / Für und Wider der laparoskopischen Appendektomie im Kindesalter.

The question should be cleared, if and to what extent the indication for appendectomy has changed since the beginning of the minimal invasive surgery in childhood. At first we had the chance to compare two patient groups in the different locations of the clinic for paediatric surgery in the Humboldt-University before their consolidation, because the indication for laparoscopic appendectomy was differently decided. The analysis of these two patient collectives (more than 50 children each) showed, beside the well known different preoperative parameters (age, sex allotment and anamnesis) the distinct indications finding for the minimal invasive procedure. In one group even the acute inflammatory appendicitis was excluded from the laparoscopic technique, in the other group only the sonographic proved perityphlitic abscess was excluded. In this group--corresponding to the more generous indication--there were more wound healing complications after phlegmonous and gangrenous appendicitis--even a little more (0.4%) than in a compared conventional operated collective. Cause of this reason the indication for the laparoscopic technique was defined more rigid (excluding the acute inflammatory disease), to get a high quality standard. The following 350 children after having appendektomy were analysed in the from now on merget locations under special consideration of postoperative complications. Including 54 laparoscopic procedures we saw significant less complications and registered a better average outcome including living quality criteria.