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PubMedDate not supplied

Typhoid fever in children: a fourteen-year experience.

From 1982 to 1995, 71 children admitted in our medical center were diagnosed to have typhoid fever by culture or serology. Of the 71 children, most (83%) were aged 5-15 years. These children usually presented with fever and gastrointestinal symptoms, including abdominal pain, diarrhea, nausea or vomiting, and constipation. Hepatosplenomegaly was the most common physical sign observed and abdominal tenderness ranked the second. Thrombocytopenia occurring in 9 patients (13%) was the most common mode of complication. Other complications included intestinal perforation (3%), rectal bleeding (3%), ascites or pleural effusion (4%), and meningitis (1%). The incidence of complications tended to be higher among children 5 years of age or older (p = 0.31). Most patients responded well to appropriate antimicrobial therapies. There was no mortality. Relapse was observed in two children, although both had received 10 days of chloramphenicol therapy. The clinical isolates of Salmonella typhi were susceptible in vitro to all the antibiotics tested, including chloramphenicol, which, however, showed a higher MIC90 level than other drugs tested. In conclusion, there were age-specific differences of typhoid fever in children in terms of the incidence and morbidity and antibiotic resistance of S. typhi has not been a problem in this area at least up to 1995.

Adolescent↗
PubMedDate not supplied

[Intestinal intussusception in children. Ultrasonic diagnosis].

The aim of the paper is to demonstrate a successful use of ultrasound in the diagnosis of intestinal intussusception in children. Ultrasound decreases the number of irrigographic examinations and reduces diagnostic exposure of children to X-rays. In the last three years 35 children, aged from 3 months to 15 years (average 2 years), had a suspected clinical diagnosis of intussusception. The ultrasound studies revealed intestinal intussusception in 26 patients (74%). There were no false positive or false negative ultrasound findings. In four patients with secondary intussusception the main symptoms were identified (three solid lesions and two Meckel's diverticula). Intraluminal lesions at the apex of intussusception were confirmed by surgery. In 22 patients intussusception was idiopathic. In 15 of these patients (68%), hydrostatic desinvaginations, under combined ultrasound and radioscopic control, were successful. High grade unsuccessful hydrostatic reductions were associated with long persistence of symptoms (2 to 9 days). Ultrasound is reliable in diagnosis of intestinal intussusception and useful in control of hydrostatic reduction. In patients with expected intestinal perforation ultrasound should be combined with fluoroscopy.

Adolescent↗
PubMed1975

Complications of dermoid tumors of the ovary.

There were 253 dermoid tumors of the ovary studied. Torsion of the pedicle with hemorrhagic infarction proved to be the most frequent complication; malignant change was the most lethal. Nine patients with malignant dermoid tumors, most of them with locally advanced disease, were treated with conservative surgery, radiation, and/or chemotherapy. The longest known survivor lived 3 years; most patients died within a year. It was concluded that a more aggressive surgical approach might salvage some patients with locally advanced malignant disease.

Adolescent↗
PubMed1975

Tuberculous enteritis. Review of a protean disease.

Prior to the advent of antituberculosis drugs, at least 70% of patients with far advanced pulmonary tuberculosis had tuberculous enteritis. Despite the effectiveness of drug therapy, overt cases of tuberculous enteritis occur in the United States and particularly among immigrants from endemic areas. Clinicians often forget to consider this entity. The patient may have no or minimal abdominal complaints. Vague abdominal distress, anorexia and weight loss can be overlooked because of the extensive pulmonary exudative or cavitary disease. Even after an enteric lesion is identified, often it is mistaken for other entities, particularly neoplasm or Crohn's disease. Obviously, the diagnosis is difficult but certain radiological criteria can be indicative of the disease. This report demonstrates the protean manifestations of this entity, the complications which occur despite drug therapy and the need for continued awareness of its existence.

Adult↗
PubMed2000

[Help during the paratyfoid-A epidemic in Kirkenes in 1943-44].

Finnmark is the northernmost county in Norway. Kirkenes played a prominent part in the Second World War, and suffered 328 Russian bombing raids. In June 1943, there was an outbreak of paratyphoid A in the town. Its water reservoirs were heavily contaminated from a camp for Russian prisoners of war. In November the situation became disastrous with 208 new cases. Six advanced medical students from Oslo and 16 volunteering Red Cross nurses were sent to Kirkenes for medical support. Their biggest problem turned out to be the large number of convalescent carriers excreting bacilli in the faeces. A provisional bacteriological laboratory was established. Almost the entire population of Sør-Varanger (10,000 inhabitants) was vaccinated with combined typhoid and paratyphoid A and B vaccine (TAB). The children were also vaccinated against diphtheria. Obviously the TAB vaccine did not protect against paratyphoid A. Officially, 254 Norwegian cases of paratyphoid A were registered in the course of the epidemic; the true number, however, was probably about 300. There was only one death, from intestinal perforation.

Adult↗
PubMed1998

Paediatric liver transplantation: Queen Mary Hospital experience.

OBJECTIVE: To assess the results of paediatric liver transplantation in our institution. METHODS: From September 1993 to November 1996, 10 living-related liver transplants (LRLT) and 3 reduced-size liver transplants (RSLT) were performed on 12 children at our hospital. The medical records of the patients were reviewed. All patients suffered from end-stage liver disease resulting from biliary atresia with failed Kasai's operations. Their ages at initial transplantation ranged from 8 months to 11 years. Excluding the 2 older children aged 7.5 and 11 years, the remaining patients were aged 10.5 months on the average and weighed 6 to 9.5 kg (mean: 6.8 kg) at the time of initial transplantation. RESULTS: All living donors were discharged on postoperative day 4 to 8 and resumed their previous normal activities. All recipients were alive with normal liver function and growing after a follow-up period of 3-40 months (mean: 21 months). The patient survival rate was 100%. One patient with RSLT had hepatitis of undetermined aetiology and underwent retransplant with a graft from her mother. The graft survival rate was 92%. Postoperative complications included: postoperative bleeding (n = 3), hepatic vein stenosis (n = I), biliary-enteric anastomotic stenosis (n = 3), intestinal perforation (n = I) and portal vein thrombosis (n = I). They were all treated promptly. In all patients, the hepatic artery (diameter ranged from 1.5 to 2.5 mm) anastomosis was achieved by microvascular technique. There was no hepatic artery thrombosis in our patients. CONCLUSION: With technical refinements, early detection and prompt treatment of complications, and advances in immunotherapy, excellent results can be achieved in paediatric liver transplantation.

Biliary Atresia↗
PubMed1975

Traumatic duodenal injuries: an analysis of 32 cases.

Thirty-two patients were treated for duodenal and associated injuries during the past five years. Fifty-nine per cent resulted from penetrating trauma, while 41 per cent were secondary to blunt injury. The incidence of blunt trauma represents a fourfold increase from previously published series. The morbidity rate still remains high at 47 per cent, with fistulas and infections being the most common complications. The mortality rate was 9.3 per cent, with death resulting from major intra-abdominal vascular injuries. Awareness of the potential injury to the duodenum, aggressive resuscitative measures, early operative management and improved postoperative care can lead to further reduction of these figures.

Abdominal Injuries↗
PubMed1998

[Diagnosis and surgical treatment of tuberculosis of mesentric lymph nodes].

OBJECTIVE: To evaluate the diagnosis, operative indication and therapeutic result of tuberculosis of mesentric lymph nodes. METHOD: Fifty-nine cases with tuberculosis of mesentric lymph nodes surgically treated at two hospitals from July 1976 to July 1997 were retrospectively analyzed. RESULT: Only 14 cases were correctly diagnosed before operation. Operative treatment for the tuberculosis of mesentric lymph nodes represented a safe, effective treatment with few complications and no operative death. CONCLUSION: Because patients with tuberculosis of mesentric lymph nodes show no characteristic manifestations, laboratory methods (e.g. polymerase chain reaction), peritoneoscopy, CT scanning and B mode ultrosound techniques should also be considered for diagnosis of the disease. The acute or chronic ileus, hemorrhage of digestive tract, intestinal perforation or fistula, intra-abdominal large tuberculous abscess and abdominal sinus caused by tuberculosis of mesentric lymph nodes should be surgically treated. The exploratory laparotomy also should be performed on the patients with abdominal mass or those whose diagnosis of neoplasm could not be ruled out. The postoperative antituberculosis chemotherapy should be continued to decrease the occurrence of complications.

Adolescent↗
PubMed2001

Bowel injury as a complication of induced abortion: a case report and literature review.

Intestinal perforation is a rare complication of induced abortion. It is most commonly seen in countries in which abortions are performed by people without proper training and with improvised instruments. Bowel perforation occurs when the posterior vaginal wall or uterus is violated, allowing the instrument to pierce underlying structures. The ileum and sigmoid colon are the most commonly injured portions of bowel due to their anatomic location. A case is reported of a 17-year-old woman who sustained a perforation of her anterior rectal wall from an abortion in Haiti. The literature on this type of injury is reviewed as well as the surgical management of these injuries.

Abortion, Induced↗
PubMed2002

Religious sensitivity pitted against the need to know: autopsy of Jewish children in Israel.

BACKGROUND: The aim of the study was to compare autopsy findings with antemortem findings in children who died in a pediatric intensive care unit. MATERIAL/METHODS: Consecutive series of patients who died in the pediatric intensive care unit during 2-year period were used. The study was conducted as a retrospective chart review at community, regional-referral, university-affiliated tertiary medical center of 1200 bed in Israel. RESULTS: Permission was given to perform autopsies on only 10 children (23.8%, mean age 85.7 months) out of the 42 who died during the study period. The mean length of stay in the pediatric intensive care unit prior to death was 13.3 days. Cardiac or hemato-oncologic diseases comprised the major pre-admission diagnoses. The autopsy revealed a major finding that, if known before death, would have altered clinical management in 50% of the patients: pneumonia, pneumonitis as well as intestinal perforation or necrosis. No correlation was found between patient length of stay in the intensive care unit and the autopsy disclosed information. CONCLUSIONS: Our findings support the importance of autopsy assessment in the pediatric intensive care setup. We believe that postmortem examination is also essential for improving the quality of pediatric patient care.

Adolescent↗
PubMed2000

[Granulomatous peritonitis due to Ascaris lumbricoides].

Ascaris lumbricoides is one of the most common and most widespread helminthic infections of humans. Infection with ascaris appears to be asymptomatic in the vast majority of cases, but may produce serious pulmonary disease or obstruction of biliary or intestinal tract in a small proportion of infected people. We examined under the light of literature this case which caused the granulomatous peritonitis by ascaris, the adult worm, without any evidence of intestinal perforation.

Adult↗