Meniskusl?sionen bei Kindern

Until recently several categories of rare meniscus lesions in children received little attention in the orthopedic literature although several had been described many years previously. Instabilities of the posterior horn of the lateral meniscus, very often without concomitant structural lesions, isolated radial tears of the lateral meniscus, meniscal root tears as well as meniscocapsular or meniscosynovial lesions have very often neither been recognized nor been treated, sometimes because of technical limitations of the currently available techniques. The present report describes these lesions in children as well as classical and innovative repair techniques.     

Qualitätszirkel Manuelle Medizin bei Kindern

Manual medicine is becoming more important not only for treatment of pain syndromes but also for therapy of pediatric neurological and developmental disorders. Manual medicine goes beyond the borders of orthopedics and necessitates an interdisciplinary training and quality assurance. Therefore, the formation of quality circles is recommended. Possible topics for a quality circle are suggested.     

Schmerztherapie bei chronisch schmerzkranken, schwer beeintr?chtigten Kindern und Jugendlichen

Background

A prospective study controlled for sex and age was conducted evaluating the success of a 3-week inpatient pain therapy after 3, 6 and 12?months for 200?children and adolescents severely disabled due to chronic pain.

Methods

The following validated German questionnaires were used: pain questionnaire (DSF-K/J/E), pain coping inventory (PPCI-R), anxiety questionnaire (AFS) and depression questionnaire (DIKJ). After an intention-to-treat analysis unifactorial und multifactorial variance analyses were conducted. A significance level of p<0.01 was used.

Results

Durable improvements were observed for average pain intensity, pain disability, days absent from school, depression and for passive and interaction-based pain coping strategies 3?months after finishing inpatient pain therapy. On the other hand general anxiety and school aversion were only reduced at 6 and 12?months, respectively. Girls reported more pain in general and during follow-up. Younger children relied in general more on others when dealing with their pain.

Conclusion

An inpatient pain therapy can help children and adolescents severely disabled due to chronic pain not only in the short term but also in the long term.     

Medikamentöse Schmerztherapie bei Kindern und bei älteren Menschen

The subject of treatment of pain in children and elderly patients has been neglected to date. This symposium deals with the problems of pain treatment in these two age groups and shows the importance of adequate therapy to improve their quality of life.     

Spinalanästhesie bei der Arthroskopie des Kniegelenks

BACKGROUND AND OBJECTIVE: Intrathecal morphine provides effective postoperative analgesia but is associated with the risk of respiratory depression. A dose of only 0.1 mg has been shown to be optimal for effective and safe pain relief after abdominal surgery. This study was designed to determine whether the addition of 0.1 mg of morphine to the local anesthetic for spinal anesthesia produces adequate analgesia following arthroscopic knee joint surgery. METHODS: A prospective, randomized, placebo-controlled, double-blind clinical trial was performed. Forty ASA I/II patients undergoing knee arthroscopy under spinal anesthesia were randomized to receive either mepivacaine 4% with 0.1 mg of morphine or mepivacaine 4% with saline (placebo) intrathecally. Postoperative analgesia consisted of intravenous morphine delivered by patient-controlled analgesia (bolus: 2 mg, lockout time: 5 min). During the study period of 24 h, pain intensity at rest and on movement (visual analogue scale, 0: no pain, 100: maximum pain), vigilance, and vital parameters were recorded every hour. RESULTS: There were no statistically significant differences between the two groups in postoperative pain scores, morphine requirements, vigilance, blood pressure, heart rate, and breathing frequency. The patients of the morphine group required 12.3+/-10.2 mg (mean+/-SD) and those of the placebo group 11.6+/-8.4 mg of intravenous morphine from patient-controlled analgesia. The pain scores at rest and on movement were 10.0+/-8.1 and 16.0+/-12.6 in the morphine group and 8.2+/-7.9 and 11.7+/-11.3 in the placebo group. We did not observe severe side effects in any of the patients. CONCLUSION: Intrathecal administration of 0.1 mg of morphine does not contribute to postoperative analgesia after arthroscopic knee joint surgery.     

Schmerztherapie bei Kindern und Jugendlichen mit Hämophilie

Background

Children and adolescents with severe hemophilia commonly suffer from acute and chronic pain as a consequence of hemophilia-related bleeding. Intervention-related pain also plays a major role. Despite its high prevalence in this patient group, hemophilia-related pain is not always adequately addressed and sufficiently treated.

Objectives

This paper discusses how to improve pain management for children and adolescents (0–18 years) with hemophilia and which specific features in this population should influence decisions in pain management.

Materials and methods

An expert panel discussed challenges in pain treatment in children and adolescents with hemophilia. Recommendations are based on evidence and clinical experience.

Result

Pain management in children with hemophilia needs improvement. Children with hemophilia are at risk of developing chronic pain and of suffering traumatization due to insufficient pain management. Pain therapy can be challenging in these children as both their age and the underlying disease limit the options in particular in pain medication. The expert panel developed recommendations to improve pain management in children with hemophilia.

     

Die verletzte Halswirbelsäule bei Kindern und Jugendlichen

Trauma of the infant or juvenile spine is a very rare occurrence (less than 2%). Nevertheless, it is almost always dramatic. In 21 years 1630 patients with spinal cord injuries were treated. Of these, 21.7% (357 patients) had injuries in the area of the cervical spine. 23 patients (1.4%) were younger than 17.5 years, 8 of them were younger than 10 years. In 10 cases the cause was a traffic accident, in 7 cases it was a jump in too shallow water. In 4 times other leisure activities were the cause. A fall from a window sill and a falling tree were further reasons. Neck segment C0 to C3 was involved eight times, segment C3 to C7/Th1 was involved 15 times. The average age of the group with injuries in C0 to C3 was 5.6 years, in the group with injuries of segments C3 to C7/Th1 it was 15.8 years. In 11 cases the trauma caused complete tetraplegia, in six cases the paralysis was partial. In six further cases no neurological deficit occurred. 14 cases were treated surgically, six were treated conservatively. Four children younger than 10 years with complete tetraplegia died. In seven cases tetraplegia persisted; out of six patients with incomplete neurological deficit three improved and three patients recovered completely.     

Chronische Peritonealdialyse bei Kindern — Ergebnisse der Kinderdialyse Wien

BACKGROUND: Peritoneal Dialysis (PD) has been increasingly used as primary renal replacement therapy in children over the last 10 years. The aim of this study was to investigate complications of PD and compare the collected data with our own historical data and data from the literature. PATIENTS AND METHODS: 33 children (17 boys, mean age 4.9 years) who underwent PD for the first time due to chronic renal failure between 1994 and 2003 were enrolled in this retrospective survey. RESULTS: 398 months on PD in total, with a mean time of 12 months per patient were investigated. The occurrence rate of peritonitis was one per 14.2 months and for exit-site-infection one per 13.2 months. 23 children underwent renal transplantation, one child was switched to hemodialysis, two children died (one because of PD-unrelated circumstances), reflecting a 1-year survival rate of 94%. CONCLUSIONS: Peritoneal dialysis has become the most frequently used modality of renal replacement therapy in children, with a trend towards smaller children and infants. PD can be managed safely and successfully in children of all age groups, including even newborns.     

Ist die Supplementierung der Ohrakupunktur bei operativer Zahnentfernung in Lokalanästhesie effektiv?

Background

The application of ear acupuncture can contribute to a reduction of acute pain. Data on the application of ear acupuncture following oral surgery in odontology is insufficient.

Objective

This study investigated the effectiveness of ear acupuncture as an auxiliary analgesic treatment in addition to local anesthesia for operative tooth removal.

Methods

In this prospective open non-randomized pilot study (in accordance with the CONSORT publication) 2 cohorts of 50 patients each with the indications for an operative tooth removal either with or without the application of ear acupuncture in addition to local anesthesia with articain were observed. Patients were allocated to the groups according to their preference. Pain intensity while resting and while chewing was recorded as the primary parameter for a period of 10 days. The secondary parameters were the subjective experience of anxiety and symptoms, such as headaches, dizziness and nausea.

Results

The two groups did not differ significantly with respect to demographic variables or the use of local anesthetics. At the various measurement intervals, pain intensity while resting or chewing differed significantly between the two groups (ANOVA, p = 0.004, p = 0.007, respectively). Furthermore, the experience of anxiety (ANOVA, p = 0.0001), the number of patients taking analgesics (χ²-test, p = 0.017) and the total postoperative consumption of analgesics (t-test, 0.001) revealed significant differences. In both groups the numerical rating scales (NRS) for postoperative headaches, dizziness and nausea were low.

Discussion and conclusion

Despite a potential bias and methodological limitations of the study design, the results of this investigation suggest that ear acupuncture influences the experience of pain and anxiety in the postoperative period after tooth removal. As a treatment method with low adverse effects ear acupuncture can contribute to postoperative pain control, especially in patients with preoperative anxiety.

     

Österreichische interdisziplinäre Handlungsempfehlungen zum perioperativen Schmerzmanagement bei Kindern

These recommendations were originally commissioned by the“Österreichische Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin” (ÖGARI, Austrian Society for Anesthesiology, Resuscitation and Intensive Care Medicine). Against this background, Austrian experts from the disciplines anesthesiology, pain management, pediatrics and the “Berufsverband Kinderkrankenpflege” (Professional Association of Pediatric Nursing) have with legal support developed evidence-based and consensus recommendations for the clinical practice. The recommendations include key messages which cover the most important recommendations for the individual topics. The complete recommendations on pediatric perioperative pain management consist of seven separate articles which each deal with special sub-topics with comments on and explanations of the key messages. The target groups of the recommendations are all medical personnel of the individual disciplines involved in the treatment of perioperative and posttraumatic pain for neonates, infants and children up to 18 years old.     

Komplexbehandlung mit Manueller Medizin und Physiotherapie bei zerebral bewegungsgest>örten Kindern

The “complex therapy” of children affected by motor disturbances includes various techniques of muskulo-sceletal medicine following the guidelines of the Deutsche Gesellschaft für Manuelle Medizin combined with different physiotherapeutical treatment techniques. Goal of the treatment is the decrease of reversible dysfunctions of muscles and joints to improve motor function and in consequence the decrease of motor developmental delay. In order to evaluate this conception 80 children affected by cerebral palsy (m/f=1,7; average of age=5,8 yrs) were assessed by the “Gross Motor Function Measure” (GMFM) before and after a 2 week daily treatment. The children showed a remarkable gain of gross motor function within these two weeks.     

Risikofaktoren für Rückenschmerzen bei Kindern und Jugendlichen in Industrienationen

Factors that have led to the increasing prevalence of back pain amongst children and adolescents living in industrialized nations are mostly unknown. The following literature review was aimed at determining the risk factors for back pain amongst children and adolescents. We searched both PUBMED and MEDLINE between the years 1985 and 2003 for the keywords "children or adolescents" and "back pain". Only data published in original articles were used. The risk for suffering back pain is influenced by physical, behavioural, emotional and social factors. The effects of physical activity, sitting, muscle status, weight of schoolbags, exercise, television and computer use, as well as age and gender on the development of back pain in children and adolescents were examined. Associations between continuous or recurring back pain and psychosocial factors (lifestyle, emotional factors, social relationships) could be demonstrated. There was no relationship between changes of the spine seen by radiological tests and the development of chronic back pain. Longitudinal epidemiological studies are urgently needed to delineate the risk factors for the development as well as the natural history of chronic back pain in the young.     

Dysfunktionen der Kopfgelenke in Abhängigkeit vom Computergebrauch bei Kindern und Jugendlichen

Background

Cervicocranial problems seem to be appearing more commonly among school children. We performed a study to examine the frequency of such a dysfunction and whether computer use had an effect on frequency.

Material and Method

Based on 759 questionnaires answered by primary and secondary school children, the study population was divided into two groups according to time spent on the computer. In total, 161 pupils demonstrating the most and the least time spent on the computer underwent manual and inclinometric tests.

Results

A total of 74% of pupils had obvious signs of dysfunction; 65% of primary school children who spent little time on the computer and 74% of those who spent significant time on the computer showed signs of dysfunction. The secondary school results were 77% vs. 80%, respectively.

Discussion

The number of pupils with cervicocranial problems was surprisingly high. There was only slight difference between the age groups tested. A trend towards increasing problems with age could be found. School as a causal factor requires investigation.     

Kraniomandibuläre Dysfunktion bei Kindern mit Funktionsstörungen im zervikookzipitalen Übergang

The presence of a cross or overbite, teeth grinding and pressing, myofunctional disorders, a deviation in the resting tongue position, sucking habits, jaw pain or headaches, postural disorders, and migraine in children may be first predictors of juvenile craniomandibular disorders (CMD). The cause is usually found in a deviation of postural control development in early childhood. Particularly functional disorders in the upper cervical region can influence jaw position. Already in the first few months of life, the course is set for further development—with effects on the entire body, e.?g., altered statics or non-physiological coordination. The most common postural deficits associated with muscular CMD in children are a forward head posture, hyperlordosis, and genu valgum, as well as scoliosis with uneven shoulders in patients with midline deviations. Children benefit from manual medical therapies, neurofunctional training, speech therapy, and a lot of exercise.     

Dreiwöchige stationäre multimodale Schmerztherapie bei Kindern und Jugendlichen mit chronischen Schmerzen

OBJECTIVE: In children and adolescents we investigated the impact of a 3-week inpatient multimodal pain therapy on subjective burden of life, pain intensity, and number of days off from school 3, 6, or 12 months later. METHODS: At the beginning of therapy (inpatient setting) and 3, 6, and 12 months thereafter (outpatient setting) we collected the respective data using standardized questionnaires. For statistical analysis we used Wilcoxon's signed rank test. A p <0.05 was regarded as statistically significant. RESULTS: A total of 72 patients aged 7.5-18.2 years suffering daily pain entered the study, most of them being diagnosed with somatoform pain disease. After 3, 6, and 12 months, 65, 27, and 30 patients could be reevaluated. Mean pain intensity of the week before data acquisition was significantly less than at the beginning (2.9, 2.3, and 2.9 vs 6.3) as was the mean number of days off from school due to pain during the 4-week period before each day of data acquisition (1.8, 1.5, and 1.4 vs 9.2). Mean subjective burden of life was significantly less than at the beginning (24.5, 22.0, and 25.8 vs 37.8). CONCLUSION: Outpatient multimodal pain therapy has a sustained impact on children and adolescents suffering from chronic pain.