Peter Michael Klimek

Trampoline related injuries in children: risk factors and radiographic findings

BackgroundBackyard trampolines are immensely popular among children, but are associated with an increase of trampoline-related injuries. The aim of this study was to evaluate radiographs of children with trampoline related injuries and to determine the risk factors.MethodsBetween 2003 and 2009, 286 children under the age of 16 with backyard trampoline injuries were included in the study. The number of injuries increased from 13 patients in 2003 to 86 in 2009. The median age of the 286 patients was 7 years (range: 1–15 years). Totally 140 (49%) patients were males, and 146 (51%) females. Medical records and all available diagnostic imaging were reviewed. A questionnaire was sent to the parents to evaluate the circumstances of each injury, the type of trampoline, the protection equipment and the experience of the children using the trampoline. The study was approved by the Institutional Ethics Committee of the University Hospital of Bern.ResultsThe questionnaires and radiographs of the 104 patients were available for evaluation. A fracture was sustained in 51 of the 104 patients. More than 75% of all patients sustaining injuries and in 90% of patients with fractures were jumping on the trampoline with other children at the time of the accident. The most common fractures were supracondylar humeral fractures (29%) and forearm fractures (25%). Fractures of the proximal tibia occurred especially in younger children between 2–5 years of age.ConclusionsChildren younger than 5 years old are at risk for specific proximal tibia fractures (“Trampoline Fracture”). A child jumping simultaneously with other children has a higher risk of suffering from a fracture.

Outcome in neonates with necrotizing enterocolitis and patent ductus arteriosus.

BackgroundThere is no agreement of the influence of patent ductus arteriosus (PDA) on outcomes in patients with necrotizing enterocolitis (NEC). In this study, we assessed the influence of PDA on NEC outcomes.MethodsA retrospective study of 131 infants with established NEC was performed. Outcomes (death, disease severity, need for surgery, hospitalization duration), as well as multiple clinical parameters were compared between NEC patients with no congenital heart disease (n=102) and those with isolated PDA (n=29). Univariate, multivariate and stepwise logistic regression analyses were performed.ResultsBirth weight and gestational age were significantly lower in patients with PDA [median (95% CI): 1120 g (1009-1562 g), 28.4 wk (27.8-30.5 wk)] than in those without PDA [median (95% CI): 1580 g (1593-1905 g), 32.4 wk (31.8-33.5 wk); P<0.05]. The risk of NEC-attributable fatality was higher in NEC patients with PDA (35%) than in NEC patients without PDA (14%)[univariate odds ratio (OR)=3.3, 95% CI: 1.8-8.6, P<0.05; multivariate OR=2.4, 95% CI: 0.82-2.39, P=0.111]. Significant independent predictors for nonsurvival within the entire cohort were advanced disease severity stage III (OR=27.9, 95% CI: 7.4-105, P<0.001) and birth weight below 1100 g (OR=5.7, 95% CI: 1.7-19.4, P<0.01).ConclusionsIn patients with NEC, the presence of PDA is associated with an increased risk of death. However, when important differences between the two study groups are controlled, only birth weight and disease severity may independently predict mortality.

Clostridium perfringens and necrotizing enterocolitis

regimens evaluated, extensively hydrolyzed protein formula with and without the addition of lactobacillus GG. If baseline values were artificially higher because of the presence of blood, it should have affected stools from both dietary groups equally and thus had no impact on results. Savino et al state that we did not clarify whether patients had anal fissures or gastroesophageal reflux. None of the patients studied had anal fissures, and we are not sure why gastroesophageal reflux had to be ruled out in infants whose only symptoms were blood and mucus in the stool. Finally, Savino et al state that they found higher FC levels in breastfed infants compared with formula-fed infants. That seems to be in contrast with the findings of Campeotto et al, who reported no differences related to type of feeding.

The anterior tilt angle of the proximal tibia epiphyseal plate: A significant radiological finding in young children with trampoline fractures

OBJECTIVE Evaluation of the anterior tilt angle of the proximal tibia epiphyseal plate in young children, which suffered a trampoline fracture in comparison with a normal population. MATERIALS AND METHODS 62 children (31 females, 31 males) between 2 and 5 years of age (average 2 years 11 months, standard deviation 11 months) with radiographs in two views of the tibia were included in this retrospective study. 25 children with proximal tibia fractures were injured with a history of jumping on a trampoline. All other causes for tibia fractures were excluded. A normal age-mapped control cohort of 37 children was compared. These children had neither evidence of a trampoline related injury nor a fracture of the tibia. The anterior tilt angle of the epiphyseal plate of the tibia was defined as an angle between the proximal tibia physis and the distal tibia physis on a lateral view. Two radiologists evaluated all radiographs for fractures and measured the anterior tilt angle in consensus. An unpaired Students t-test was used for statistical analysis (SPSS). Original reports were reviewed and compared with the radiological findings and follow-up radiographs. RESULTS In the normal control group, the average anterior tilt angle measured -3.2°, SD ± 2.8°. The children with trampoline fractures showed an anterior tilt of +4.4°, SD ± 2.9°. The difference was statistically significant, P<0.0001. In 6 patients (24% of all patients with confirmed fractures) the original report missed to diagnose the proximal tibial fracture. CONCLUSION Young children between 2 and 5 years of age are at risk for proximal tibia fractures while jumping on a trampoline. These fractures may be very subtle and difficult to detect on initial radiographs. Measurement of the anterior tilt angle of the proximal tibia epiphyseal plate on lateral radiographs is supportive for interpreting correctly trampoline fractures.

Effects of potato-derived protease inhibitors on perianal dermatitis after colon resection for long-segment Hirschsprung’s disease

BackgroundAfter resection of long-segment Hirschsprung’s disease, severe perianal dermatitis (SPAD) may occur because of high stool frequency and elevated concentrations of fecal pancreatic proteases. We investigated prospectively the effect of potato-derived protease inhibitors (PPI) on skin conditions in children with postoperative SPAD.MethodsFour children (aged 12 to 24 months) with therapy-resistant SPAD after transanal endorectal pull-through for long-segment Hirschsprung’s disease received topical PPI (1% in 20% zinc ointment) with each diaper-change. Parents noted down a subjective dermatitis score daily. Photo documentation and outpatient visits were made to assess the treatment results.ResultsNo adverse effects were observed after treatment with PPI. A remarkable improvement of the dermatitis in 3 of the 4 patients as well as improvements in pain and sleep disorders were observed during the PPI-treatment course.ConclusionThe results of the study suggest that PPI may reduce otherwise intractable protease-induced skin irritation in infants.

Hematometra presenting as an acute abdomen in a 13-year-old postmenarchal girl: a case report

IntroductionMost underlying diseases for abdominal pain in children are not dangerous. However some require rapid diagnosis and treatment, such as acute ovarian torsion or appendicitis. Since reaching a diagnosis can be difficult, and delayed treatment of potentially dangerous diseases might have significant consequences, exploratory laparoscopy is a diagnostic and therapeutic option for patients who have unclear and potentially hazardous abdominal diseases. Here we describe a case where the anomaly could not be identified using a laparoscopy in an adolescent girl with acute abdomen.Case presentationA 13-year old postmenarchal caucasian female presented with an acute abdomen. Emergency sonography could not exclude ovarian torsion. Accurate diagnosis and treatment were achieved only after an initial laparoscopy followed by a laparotomy and after a magnetic resonance imaging scan a further laparotomy. The underlying disease was hematometra of the right uterine horn in a uterus didelphys in conjunction with an imperforate right cervix.ConclusionThis report demonstrates that the usual approach for patients with acute abdominal pain may not be sufficient in emergency situations.

Low L-Ficolin associated with disease severity during sepsis in adult ICU patients

Dear Editor, Foldi et al. reported that LFicolin (FCN2) plasma values were lower in patients with cirrhosis compared to healthy adults.1 In addition low level of FCN2 was associated with development of significant bacterial infections.1 However, it remains unclear whether low FCN2 level may be associated with disease severity in infectious diseases. In order to investigate the role of pattern recognition molecules of the lectin complement pathway during sepsis, we assessed plasma levels of MBL, MASP2, MASP3, HFicolin and LFicolin in a prospective study including 30 adult patients with sepsis requiring admission to our intensive care unit.2 The study protocol was approved by the regional governmental ethics committee (Ethik Kommission des Kantons Bern). Written informed consent was obtained from the patients or their relatives. Levels were measured 12 hourly for 48 hours and at discharge. Concentrations of lectin pathway proteins except LFicolin were within normal ranges and remained relatively stable.3 Overall LFicolin concentrations were lower as compared to healthy adults3 (at entry median 3831; CI95% 37406483 ng/mL) and were significantly lower in patients with severe sequential organ failure assessment (SOFA)score (SOFAscore≥10; n=15), persisting for each observation time point (P<.05 respectively) (Figure 1). Our results support the findings of Foldi et al., whose results suggest a correlation between low FCNs and immune dysfunction, and warrant for larger studies to define the role of LFicolin in both, patients with liver disease and infections. ACKNOWLEDGEMENTS

Congenital Heart Disease Increases Mortality in Neonates With Necrotizing Enterocolitis

Background: Studies on the influence of congenital heart disease (CHD) on neonates with necrotizing enterocolitis (NEC) have produced varied results. We therefore examined the influence of CHD on NEC outcomes. Methods: We carried out a retrospective single-center study including infants with confirmed NEC, treated between 2004 and 2017. We excluded patients with isolated patent ductus arteriosus or pulmonary hypertension (n = 45) and compared outcomes of patients with hemodynamically relevant CHD (n = 38) and those without CHD (n = 91). Results: Patients with CHD were more mature than those without CHD [gestational age, median, 95% confidence interval (CI95), 37.1, 34.5–37.2w, vs. 32.6, 31.9–33.3w; P < 0.01]. The presence of CHD did not influence the frequencies of severe disease (overall 21% Bell stage III), nor surgical interventions (overall 30%), the occurrence of intestinal complications (overall 13%), nor the duration of hospitalization (overall 38 days in survivors). The overall mortality as well as NEC-related mortality was increased with the presence of CHD, being 50% (19 out of 38) and 13% (5 out of 38), respectively, when compared to patients without CHD, being 8% (7 out of 91) and 3% (3 out of 91). The presence of CHD and of advanced NEC stage III were independent predictors of NEC-associated fatalities with multivariable odds ratios (CI95) of 7.0, 1.3–39.5 for CHD, and of 3.4, 1.6–7.5 for stage III disease. Conclusions: While some outcome parameters in neonates with NEC remained unaffected by the presence of CHD, the mortality risk for patients with CHD was seven times higher than without CHD.

Gallensteine bei Kindern

Bei Kindern unter sechs Jahren kommen am haufigsten Bilirubinsteine vor (etwa 70%, meist rontgendicht), gefolgt von Kalzium-BilirubinatSteinen, welche ab dem sechsten Lebensjahr dominieren. Cholesterinsteine nehmen mit zunehmendemAlterderKinderzu, sind jedochcharakteristisch fur das Erwachsenenalter [4]. Die Hauptursache fur die Entstehung von Pigmentsteinen sind hamolytische Erkrankungen, welche zur Erhohung der Bilirubinkonzentration in der Galle fuhren. Das Bilirubin verbindet sich anschliessend mit Kalzium zu schwerloslichen Komplexen (Kalzium-Bilirubinat). Anhand der Literatur und eigener Ergebnisse wurde die folgende Liste mit Erkrankungen zusammengestellt, welche insbesondere im Kindesalter zu einer Cholezystolithiasis fuhren konnen: – Hamatologische Erkrankungen: Thalassamie, Sichelzellanamie, Spharozytose, Eliptozytose, Glukose-6-Phosphat-Dehydrogenase-Mangel, Pyruvatkinasemangel, Autoimmunhamolyse. – Stoffwechselerkrankungen: Hypothyreose, M. Wilson, Storungen des Kalzium-PhosphatStoffwechsels, Malabsorptionssyndrome (z.B. M. Crohn), Zystische Fibrose. – Medikamente:Ceftriaxon,Cyclosporin,hormonale Kontrazeptiva. – Andere Ursachen: Fruhgeburtlichkeit, parenterale Ernahrung, Leberzirrhose, chronische Cholestase, biliare Dyskinesien, familiare Belastung, schnelle Gewichtsabnahme, Adipositas, Schwangerschaft im adoleszenten Alter, Kurzdarmsyndrom, Abflussstorungen, anatomische Abnormalitaten. – Idiopathische Cholezystolithiasis.