Ludwig Lazar

Volvulus of the stomach in childhood: The spectrum of the disease

Introduction During a 5-year time frame, five cases of symptomatic gastric volvulus were diagnosed and treated in our department. Four presented with the acute form of gastric volvulus and underwent emergency surgery. The fifth suffered the chronic variant of the syndrome and was benefited by nonoperative management. The cases serve to remind emergency physicians of the spectrum of gastric volvulus. The report supplements the sparse clinical description in the emergency literature. Results In the operated patients, there were no postoperative complications. The outcome, to the time of publication, has been good in every instance. The history, etiology, presentation, and treatment of the disease are discussed in detail. Conclusions Not infrequently, gastric volvulus in children fails to exhibit the full gamut of signs and symptoms such as abdominal distension, vomiting, pain, and retching. For this, as well as for other stated reasons, symptomatic gastric volvulus in infancy and childhood may not be as rare as is commonly assumed.

Abdominal Injuries caused by Bicycle Handlebars

OBJECTIVE To find out whether the increase in the number of children admitted with injuries from mountain bicycle handlebars is attributed to recent changes in the design of childrens bicycles. DESIGN Retrospective study. SETTING Teaching general hospital, Israel. SUBJECTS 76 children who presented with abdominal injuries caused by bicycle handlebars. RESULTS In 12 of the 76 children, there was an imprint of the handlebar edge on the hypochondrium. The most common injuries were isolated ruptures of spleen or liver, (14 and 11 patients, respectively). Five of the 25 patients were operated on and the rest treated conservatively. CONCLUSIONS Children with an imprint or bruise made by the handlebar edge on the abdominal wall, or who give a clear history of injuries by a bicycle handlebar should be treated with great care. BMX handlebars are relatively high (for young riders) and wide; they also turn freely and are therefore in direct line with the upper abdomen. Prohibiting the use of bicycles with unpadded handlebars may prevent some of these intra-abdominal injuries.

Brain concussion produces transient hypokalemia in children

Hyperglycemia and hypokalemia caused by catecholamine discharge have been reported to occur in patients after severe head trauma. The aim of this prospective study was to evaluate whether a similar neuroendocrine and metabolic response is found in children after minor head trauma such as brain concussion (Glasgow Coma Scale (GCS) > or = 13). One hundred fifty patients aged 2 to 14 years (average, 6 years) were divided into three groups (n = 50 in each group). Group 1 included patients admitted to the emergency department for brain concussion (Glasgow Coma Scale (GCS) > or = 13); group 2 included patients admitted for fractures of long bones without head injury; and group 3 were control patients electively admitted for hernia repair. All patients had complete physical and neurological examinations. Complete blood count and blood chemistry were obtained on admission. All blood tests were repeated at 6, 12, and 24 hours in patients belonging to group 1. An electrocardiogram was obtained in selected patients and catecholamine levels were measured in some patients. Statistical analysis was performed using analysis of variance (ANOVA). Serum potassium and sodium levels in patients with brain concussion (group 1) were 3.6 +/- 0.6 and 136 +/- 3 mEq/L, respectively and were significantly lower (P < 0.01) than those in patients belonging to group 2, 4 +/- 0.4 and 138 +/- 3, respectively, and the controls (group 3), 4.2 +/- 0.5 and 140 +/- 2, respectively. Serum glucose level was 124 +/- 34 and 118 +/- 32 mg% in groups 1 and 2 and was significantly higher than that of the controls (group 3), 90 +/- 23 mg%. There was no correlation between serum electrolytes and GCS. No electrocardiogram changes or elevation of serum catecholamines were found. Hypokalemia resolved spontaneously within 24 hours. All patients recovered without neurological sequalae. Transient hypokalemia frequently occurs in children even with minor head trauma. This hypokalemia resolves spontaneously, without treatment and within 24 hours.

Elective sonographic evaluation of inguinal hernia in children — an effective alternative to routine contralateral exploration

Four hundred sonographic examinations were performed on 200 children admitted for elective inguinal hernia operations. The sonographic evaluation proved to be accurate in 92% of confirmable diagnoses and is a simple, non-invasive mode of investigating inguinal hernia and patent processus vaginalis. Our data support a policy of contralateral groin exploration during unilateral hernia repair based on preoperative ultrasonographic information.

Pernicious anemia and adenocarcinoma of the stomach in an adolescent: Clinical presentation and histopathology

Primary gastric-carcinoma accounts for only 0.05% of pediatric gastrointestinal malignancies. Although elderly patients who have pernicious anemia are at greater risk of the development of atrophic gastritis and gastric carcinoma, pernicious anemia caused by vitamin B12 deficiency is extremely rare in otherwise healthy adolescents. The authors present a 14.5-year-old boy who had dimorphic anemia caused by vitamin B12 and iron deficiencies in whom atrophic gastritis and gastric carcinoma developed. To the best of our knowledge, this association has not been previously reported in children or adolescents.

Quadriceps paresis in pediatric groin surgery

Abstract A total of 2,624 groin operations were performed in 2,202 infants and children aged 6 months–14 years during the last 4.5 years. Preventive analgesia was used in all operations, and included ilioinguinal and iliohypogastric nerve block combined with inguinal canal infiltration. In 6 patients transient postoperative quadriceps muscle paresis (QMP) was noted. They required bed rest and monitoring for a few hours, and complete spontaneous recovery was noted in all cases. The aim of this study was to examine the incidence of transient QMP following regional nerve block and to discuss models of possible prevention.

Conservative treatment of an injured hydronephrotic kidney : the role of percutaneous nephrostomy

The authors report a child who presented with massive hematuria after blunt trauma to a hydronephrotic kidney (ureteropelvic junction stenosis). The insertion of a nephrostomy tube effectively decompressed the injured kidney and enabled an early reconstructive repair of the stenosed ureteropelvic junction.

Subtotal Gastrectomy in a Teenager With Gastroparesis

Disorders of gastric emptying are rare in healthy infants and children. Delayed gastric emptying is encountered in adults after operations on the stomach, such as vagotomy and partial gastrectomy, and is extremely rare in young patients. The authors report on a 15-year-old patient with gastroparesis after three attempts to repair a congenital diaphragmatic hernia. Medical therapeutic trials consisting of all combinations of diet regimes with various gastrokinetic drugs failed to alleviate the intractable vomiting. All the patients symptoms resolved after subtotal gastrectomy with gastroduodenostomy (Billroth I).

The Value of Ultrasound in the Diagnosis of Congenital Hypertrophic Pyloric Stenosis

The charts of 103 children with a clinically and surgically confirmed diagnosis of congenital hypertrophic pyloric stenosis were retrospectively reviewed. We found a significant correlation between sonographic and surgical measurements of the muscular thickness of the pylorus (r = .987, P<.001). In 73.7% (76 cases), the clinical picture of gastric outlet obstruction was present when the thickness of the enlarged pyloric muscle was 3.0 mm or more. In 26.3% (27 cases), the pyloric muscle was less than 3.0 mm wide. For 10 patients in whom the muscle width was less than 2.5 mm by sonography, a barium meal was necessary to confirm the diagnosis. The width of the pyloric muscle is the most important factor in the sonographic diagnosis of pyloric stenosis, and even a width of less than 3.0 mm may be associated with clinically significant obstruction.

Is there a connection between paediatric acute idiopathic scrotal oedema and intestinal worm infestation

Aim:  Based on our experience with acute idiopathic scrotal oedema (AISO) and observations of the incidence of intestinal worm infestation (IWI), we decided to test the hypothesis that IWI occurs more frequently among children with AISO than it does in the general population.