Oct. 4, 2017
Volume VIII |  Issue No. 40

Fracture table application for pediatric femur fractures
A fracture table is usually used to aid reduction of a pediatric femur fracture. Complications of its use are uncertain.
A study of 260 children (<18 years of age) treated for a femur fracture with the use of a fracture table indicates that approximately 3% develop nerve palsies with "overweight" being a significant risk factor on multi-variant analysis.
Button battery (BB) ingestion in children
"Ingested foreign bodies are generally considered relatively benign." In the USA a child (primarily 1-2 year olds; but all are at risk) presents to an Emergency Department (ED) every three hours with a BB related problem (40% are not witnessed; with no history and non-specific presentations of vomiting, poor appetite, cough and lethargy). While the majority of ingested BB's pass through the bowel without causing a problem, significant injury/death (e.g. from catastrophic bleeding) can occur if they lodge in the upper airway or esophagus (particularly for batteries >20mm diameter; if of higher voltage (3v) which may cause serious burns, or from leakage of alkaline (but not lithium) into the surrounding tissues).
Prompt diagnosis of a BB ingestion is critical as it carries significant potential risks or death particularly in young children presenting with hematemesis
Natural history, pathogenesis and treatment of Evans syndrome in children
Evans syndrome (or autoimmune hemolytic anemia and autoimmune thrombocytopenia) is a very rare, chronic (with remission and exacerbations) autoimmune disorder of unknown cause (though a number of genetic defects involving immune regulation have been described) in which the immune system destroys, simultaneously or sequentially the body's red (30%) and white blood cells and/or platelets (60%). It may occur with other disorders (e.g. autoimmune lymphoproliferative syndrome, Lupus, Sjogren's syndrome, etc.). Signs and symptoms include purpura, anemia, fatigue and light headedness. Treatments include corticosteroids, intravenous immunoglobulin, and Rituximab (monoclonal antibody) which can provide long-term immunosuppression. Stem cell transplant and splenectomy is beneficial for severe and difficult to treat cases.
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Children with Obsessive Compulsive (OC) symptoms
Obsessive-compulsive disorder is fairly prevalent and many children apparently suffer from subclinical OC symptoms.
It appears from a large sample of children with OC symptoms that there are three profiles which can be distinguished:
  1. "OC specific" with only OC-specific problems.
  2. "Comorbid OC" (comorbid symptoms of ADHD, oppositional defiant disorders, autism and anxiety).
  3. "Autistic OC".

OC children may present with different clinical profiles and long term follow up is necessary.


Video Feature
Management of non-parasitic splenic cysts (NPSC) in children

For symptomatic or complicated NPSC surgical resection is indicated. Asymptomatic NPSC management remains unclear.

A retrospective multicenter study of 100 NPSC patients followed for 12.8 months indicates that:
  1. Persistent < 5mm: No treatment. (laparoscopic partial resection is indicated for cysts >5mm).
  2. NPSC size increases significantly between the ages 10-12 years.
  3. Approximately half remain stable.
  4. 57.9% who undergo cystectomy (vs. splenectomy) have recurrences.
Skin manifestations of tuberous sclerosis complex (TSC)

TSC is a rare multisystem genetic disorder that results in mostly benign tumors (hamartomas) growing in multiple different organs especially the skin, brain, heart, eyes, kidneys and lungs. Usually presenting before the age of 6 months, severity varies from mild, to children having life-threatening complications.
Early recognition of TSC-associated skin features by pediatricians allows for facilitating treatment and long-term care.
These include:
  1. Hypomelanotic macules.
  2. Angiofibromas (facial).
  3. Periungual fibromas.
  4. Shagreen patch (an elevated, ovoid, frequently rough feeling/crinkled plaque).
  5. "Confetti"-like lesions (innumerable small scattered hypo pigmented macules).
In addition, pediatricians should remember that many children with TSC present with associated neuropsychiatric abnormalities and psychotic, intellectual, academic, neurological and psychosocial manifestations.
Kawasaki disease (KD) complicated with macrophage activation syndrome (MAS - or secondary hemophagocytic lymphohistiocytosis)
"MAS is a rare and potentially fatal complication of KD".
It appears from this report of two cases and an analysis of 69 children with both KD and MAS that:
  1. 6% have MAS before KD.
  2. 21% present with both simultaneously.
  3. 73% have MAS after KD.
  4. 46% have coronary abnormalities.
  5. 13% die.
Clinicians should consider MAS in Kawasaki syndrome patients who present with fever, splenomegaly, thrombocytopenia, elevated liver enzymes and hyperferritinemia.
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