Tonsillektomie und Tonsillotomie

Tonsillotomy and tonsillectomy are most frequently performed interventions during childhood. There is a need for a critical assessment of indication by using selected criteria. The collaboration of pediatricians and ENT surgeons is essential. Tonsillotomy in children <?6 years of age is associated with lower rates of postoperative bleeding.     

Akute Leberatrophie und lcterus catarrhalis bei Geschwistern.

Zusammenfassung. Nach kurzem Überblick über ähnliche in der Literatur niedergelegte Fälle wird hier von einem 7 Jahre alten Mädchen berichtet, welches im Rahmen einer kleinen Endemie von sog. Icterus catarrhalis an akuter Leberatrophie ad exiturn kam. Bei dem ll-jährigen Bruder, welcher 3 Wochen später ebenfalls an Gelbsucht erkrankte, trat Heilung ein; auch die übrigen Kinder, bei denen Icterus unter denselben initialen Symptomen wie bei dem Mädchen aufgetreten war, sind wiederhergestellt.     

Akute disseminierte Enzephalomyelitis und Schleimhautulzerationen

Case report

We report the case of a 15-year-old Libyan girl who developed headache, gait disturbances, and vomiting in Libya. Due to multiple high-density lesions in the T2-weighted MRI pictures of the brain with an exceptional isolated lesion of the corpus callosum, diagnosis of acute disseminated encephalomyelitis was made. Because recurrent cycles of prednisolone treatment failed, the girl was transferred to our hospital. In addition to neurologic complaints such as gait disturbances, ataxia, and hypesthesia of both legs, she then developed uveitis as well as severe ulcerations of the mouth and genital region. Diagnosis of neuro-Behçet’s disease was made. Under treatment with prednisolone and azathioprine, the girl’s condition improved rapidly so that we were able to discharge her home after 4 weeks.

Discussion

The presented disease course of neuro-Behçet’s disease is quite exceptional in children, because neurologic symptoms rarely precede the typical clinical findings of Behçet’s disease in children. Furthermore, an isolated, high-density MRI lesion of the corpus callosum, like in the present case, has not been described in neuro-Behçet’s disease before. Therefore, it must be recognized that neurologic symptoms may precede Behçet’s disease by months even in children and that this disorder must be incorporated into the differential diagnosis of miscellaneous neurologic disorders.     

Akute Alkoholintoxikationen bei Kindern und Jugendlichen

Background.

According to a WHO-cross-national-survey the alcohol consumption among children and adolescents in Switzerland has risen during the last three decades.

Methods.

The present study is a retrospective analysis of 103 patients admitted to the university childrens hospital of Zurich due to alcohol intoxication during the period 1971–1997. Investigated parameters include: clinical presentation and management, quantity and type of alcohol ingested as well as sociodemographic and psychosocial factors.

Results.

The average age of the patients, 46 female and 57 males, was 11.3 years. In 39% a blood alcohol concentration (BAC) was measured: mean 1.6‰ (g/l). 30% of cases had a background of psychosocial problems. Overall we found that during the last three decades the rate of non-dependent alcohol intoxication rose, especially among females, and that the amount of alcohol consumed increases.

Conclusion.

Despite a high proportion of severe intoxications all patients survived without complications. Notwithstandig the fact that the principle aim of care is the treatment of hypoglycemias, acidosis and hypothermias a psychosocial evaluation must take place as well. Alcoholintoxication in children and adolescents is increasing and intensive prevention strategies are required.     

Akute virale Bronchiolitis und obstruktive Bronchitis bei Kindern

Monatsschrift Kinderheilkunde - Akute Bronchiolitis und obstruktive Bronchitis sind im Säuglings- und Kleinkindalter sehr häufige Krankheitsbilder. Sie werden durch Viren, v.?a....     

Profuse Lungenblutungen bei recidivierender Endocarditis und Polyarthritis im Kindesalter

Ohne Zusammenfassung Mit 1 Abbildung im Text.     

Akute Leukämien bei Kindern und Jugendlichen

Acute leukemias are the most common cancers of childhood. They are a consequence of malignant transformation of a hematopoietic progenitor cell in the bone marrow. The introduction and optimization of risk-adapted intensive polychemotherapy regimens since the 1970s have substantially increased the chances of survival. Molecular techniques now contribute significantly to the initial risk stratification and response assessment and are critical for therapy adjustment. Current efforts aim to develop effective strategies for still incurable high-risk leukemias and to reduce the considerable toxicities of therapy.     

Akute Bauchschmerzen und Makrohämaturie im Jugendalter

Ohne Zusammenfassung     

Akute haemolytische Anaemie (Lederer) mit Uraemie und Herzblock

Zusammenfassung Es wird über einen Fall von akuter haemolytischer Anaemie vom Typ Lederer berichtet, dessen Verlauf durch das Auftreten einer echten Uramie mit Pericarditis, kompletten Herzblock und Tetanie kompliziert war. Ausgang in Heilung, wie Nachuntersuchung 5 Monate nach Erkrankungsbeginn ergibt. Kurze differentialdiagnostische Betrachtungen. Die Entstehung der Wasserhaushaltsstörungen, der Kreislaufkomplikationen und der Tetanie wird besprochen.     

Approach to Polyarthritis

A child with polyarthritis is always a diagnostic challenge for the treating physician. By definition, polyarthritis, taken in context as a subgroup of juvenile idiopathic arthritis, is defined as inflammation of more than 4 joints on physical examination. Though the exact incidence and prevalence of polyarthritis in childhood is not known, it is not uncommon in pediatric practice. Polyarthritis can be a clinical manifestation of diverse disease processes and the differential diagnosis is understandably very broad. It can be caused directly by an infectious agent or indirectly by immune mechanisms, may be a component of a systemic disease process or may be idiopathic. The presentation can be acute or chronic. It can represent a benign self limiting illness requiring no specific treatment or may be a severely disabling condition with significant morbidity and, in some cases, even mortality. While in some situations it may be possible to arrive at a provisional clinical diagnosis right at the outset, in others the diagnosis gradually evolves over a period of time. As in most other arthritides, the most important aspects of the diagnosis are a thorough history and a detailed clinical examination. Relevant laboratory investigations can help in facilitating the diagnosis but can often also mislead the treating physician. Hereby we present a clinical approach to a child with polyarthritis.     

Akute Toxoplasmose-Meningoencephalitis

Zusammenfassung Es wird über einen Fall von erworbener monosymptomatischer Toxoplasmose-Meningoencephalitis bei einem 10 1/2jährigen Jungen berichtet, die klinisch bereits Spontanbesserung zeigte, bei welcher jedoch erst durch Daraprim-Supronal-Behandlung auch Entfieberung und weitgehende Befundnormalisierung des Liquors erreicht werden konnten.

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Summary This is a case report of a 10 1/2-year-old boy, admitted to the hospital with mild signs of increased intracranial pressure, subfebrile temperatures, peripheral facial nerve palsy, and marked general changes on EEG examination. Lumbar puncture revealed pleocytoses and increased protein content of the spinal fluid. Diagnosis of acquired toxoplasmosis was made by a high titer of the Sabin-Feldman dye test and a strongly positive complement fixation test, whereas other causes of the present meningoencephalitis could be ruled out. Clinical symptoms and changes of the spinal fluid responded promptly to combined therapy with Daraprim and Supronal of two weeks' duration. — Differential diagnosis is discussed, and further literature is reviewed.

     

Akute Otitis media

Immunisation with pneumococcal conjugate vaccine (PCV) protects children from invasive as well as localised infections such as acute otitis media (AOM). During the pivotal prelicensure study of the seven-valent PCV (PCV-7), efficacy against vaccine-serotype AOM was 67% and against any form of AOM was 9%. Recently, the indication of AOM has been granted for PCV-7 in the European Union. Since pneumococcal immunisation was introduced in the United States for children less than 2 years of age, further data have accumulated regarding PCV-7 efficiency against AOM. In one representative study, the overall frequency of AOM in the ambulatory setting declined by 20% in the target age group shortly after the program began. Some investigations indicate the possibility of replacement disease by other pneumococcal serotypes and other bacteria not covered by the vaccine. Further careful investigations are needed to recognise such epidemiological changes.     

Akute unilaterale Mydriasis

We report on a seven-year-old boy who presented with acute unilateral mydriasis after playing with Angel’s Trumpet, a common ornamental plant belonging to the Deadly Nightshade family. This plant contains tropane alkaloids which can cause anticholinergic symptoms following contact with or ingestion of parts of the plant. In this case the correct diagnosis was quickly established by patient history and thorough clinical examination. As expected, the symptoms resolved completely within 3 days. This case emphasizes the importance of a thorough history and clinical examination, which helped in this case to establish the correct diagnosis quickly and without the use of more expensive diagnostic procedures (e.g., computed tomography of the brain).     

Akute Otitis media

Background

Acute otitis media (AOM) is one of the most frequent conditions requiring medical attention in childhood.

Objective

This article gives an overview of the current understanding of the etiology, prevention and therapy of AOM.

Material and methods

A search of the literature was carried out in the PubMed database.

Results

The AOM mainly affects children of preschool age. Physiological immaturity of the Eustachian tube is believed to be a particularly high risk factor for compromised ventilation and infections of the middle ear in infants. Viral infections frequently precede episodes of AOM. Combined viral and bacterial infections are more frequent than infections with a single pathogen. Pneumococci and Haemophilus are the most frequent bacteria causing AOM. Young age, anatomical anomalies of the nose and upper pharynx and smoke exposure are particular risk factors. Vaccination against pneumococci, non-typeable Haemophilus influenzae and grippe are effective in preventing AOM. In contrast, antibiotic therapy has limited effectiveness as the majority of episodes spontaneously wane within several days. This has triggered the watchful waiting strategy to withhold antibiotic therapy for 2–3 days, which effectively reduces the number of antibiotic courses without increasing the risk of complications.

Conclusion

The diagnosis and therapy of AOM is one of the most frequent medical tasks in pediatrics. Vaccinations and a watchful waiting strategy for antibiotic therapy in low-risk cases are effective in reducing the burden of disease and the use of antibiotics. This article provides practical recommendations on prevention and therapy.