Transverse divergent dislocation of elbow in a child: a case report and review of current literature.

We present a case report on transverse divergent dislocation of the elbow, highlighting the spatial relation among the proximal radius, ulna, and distal humerus in this rare pediatric elbow injury and reasons leading to misinterpretation of radiographs. Elbow dislocation is a rare injury in children. It comprises only 6% of pediatric elbow injuries.

Treatment of scaphocephaly with combined vertex craniectomy and bilateral microbarrel staving.

Introduction And Background: Surgical techniques for the treatment of scaphocephaly continue to evolve; however, there is still no accepted criterion standard. Until recently, the Alder Hey supraregional craniofacial department's experience was principally with combined wide-vertex suturectomy and biparietal barrel stave osteotomies.

Aims And Objectives: To determine whether the technique of wide-vertex suturectomy and biparietal barrel stave osteotomies improves the cephalic index (CI) in scaphocephalic patients and determine whether age at surgery influences outcomes.

Right ventricular function in children with severe respiratory syncytial virus (RSV) bronchiolitis.

Background: Previous studies have demonstrated the development of myocardial damage and hepatitis in children with severe respiratory syncytial virus (RSV) infection. The aim of this study was to assess right ventricular function in children with severe RSV disease and to investigate an association with disease severity, myocardial damage, and hepatitis.

Methods: This was a prospective observational study performed at a 20-bed regional multidisciplinary tertiary pediatric intensive care unit (PICU) in a university-affiliated children's hospital.

Death by acid rain: VAP or EXIT?

Ventilator-associated pneumonia (VAP) is a new (nosocomial) lower respiratory tract infection diagnosed in mechanically ventilated patients 48 or more hours after intubation. There is no gold standard for establishing the diagnosis and its pathogenesis is iatrogenic and multifactorial. Gastro-oesophageal reflux is common in mechanically ventilated children, but its role in VAP remains speculative.

The role of neutrophil apoptosis in juvenile-onset systemic lupus erythematosus.

Objective: Accumulation of apoptotic cells may lead to the development of systemic lupus erythematosus (SLE) through a breakdown in immune tolerance. Altered neutrophil apoptosis may contribute to nuclear autoantigen exposure, ultimately leading to autoantibody generation. This study aimed to determine whether neutrophil apoptosis is altered in patients with juvenile-onset SLE as compared with controls.

Tropical primary pyomyositis in children of the UK: an emerging medical challenge.

Pyomyositis is a commonly encountered condition in the tropics. It was not described in the UK until 1998. The reason for the increasing incidence is not understood.

The behavioral consequences of exposure to antiepileptic drugs in utero.

The aim of the study was to examine the behavior of 242 children, aged between 6 and 16 years, born to mothers with epilepsy. Exposure to sodium valproate (VPA) in utero was associated with high levels of parental stress induced by the child's maladaptive behavior. These children were also poorer for daily living skills and skills relating to socialization.

Negative exploration for pyloric stenosis--is it preventable?

Background: The diagnosis of infantile hypertrophic pyloric stenosis (IHPS), although traditionally clinical, is now increasingly dependent on radiological corroboration. The rate of negative exploration in IHPS has been reported as 4%. The purpose of our study was to look at elements of supportive clinical evidence leading to positive diagnosis, and to review these with respect to misdiagnosed cases undergoing negative exploration.

Critical illness polyneuropathy following childhood appendicitis.

Surgery for childhood appendicitis is considered to have good prognosis. Critical illness polyneuropathy (CIP) is a rare devastating neuromuscular disorder characterised by profound axonal motor dysfunction of unknown aetiology. We report a unique case of CIP in a young adolescent female at a regional pediatric surgery centre following operation for appendicitis.

Surgical practice for infantile hypertrophic pyloric stenosis in the United Kingdom and Ireland--a survey of members of the British Association of Paediatric Surgeons.

Purpose: Operative strategy and antibiotic policy in treating infantile hypertrophic pyloric stenosis (IHPS) may vary widely. This study surveys current practice in the United Kingdom and Ireland among members of the British Association of Paediatric Surgeons.

Methods: The study used postal and email survey of consultant pediatric surgeons.

Oesophageal atresia with cleft lip and palate: a marker for associated lethal anomalies?

An adverse association between oesophageal atresia (OA) and cleft lip-palate (3% incidence) has been reported. The present study analyses outcomes of this rare association at a UK paediatric surgical centre. Hospital charts of newborns diagnosed with OA were reviewed.

Central venous catheter infection with Bacillus pumilus in an immunocompetent child: a case report.

Background: Bacillus organisms are common laboratory contaminants. The majority of Bacillus bacteraemias are transient and not clinically significant. Clinically significant infection due to Bacillus species is rare and mostly due to Bacillus cereus infections in immuno-compromised hosts.

The deterioration of children in ward areas in a specialist children's hospital.

Research in adult patients, in the last decade, has highlighted suboptimal care and failures in the recognition of sick adults in ward areas. In addition, many of these patients (at least 50%) demonstrated documented evidence, on observation charts, of clinical deterioration in the 24-48 h preceding cardiopulmonary arrest or emergency intensive care unit admission. However, there is little published data on whether these findings apply to children (0-17 years).

Vision impairment with an interstitial deletion of the short arm of chromosome 8.

We describe the phenotype of a male infant with an interstitial deletion of the short arm of chromosome 8 (p. 11.2-p.

Anaesthesia for spinal surgery in children.

Spinal surgery is performed in children of all age groups. Some of these children will have significant, other medical problems. For most, surgery will be performed in the prone position.

Unsuspected periventricular leukomalacia in children with strabismus: a case series.

Purpose: We report a case series of seven patients who presented with strabismus and no apparent known neurological deficit.

Methods: A retrospective review of notes was performed on all patients presenting at the Royal Liverpool Children's Hospital (Alder Hey) with strabismus, in whom subsequent investigation revealed the presence of periventricular leukomalacia (PVL).

Results: All seven patients presented with esotropia.

Evaluating the association between congenital cystic adenomatoid malformation of the lung and abdominal wall laxity.

We report a male fetus with congenital cystic adenomatoid malformation of the lung, who was treated by laser with resolution of hydrops. Postnatally, the infant had the typical abdominal wall laxity and undescended testes characteristic of prune-belly syndrome. The sonographic diagnosis of cystic adenomatoid malformation was confirmed histologically after postnatal resection.

Umbilical pyloromyotomy: comparison of vertical linea alba and transverse muscle cutting incisions.

Background: Pyloromyotomy is commonly performed through a supraumbilical skinfold incision. Entry into the peritoneal cavity can be achieved via a vertical linea alba incision or a transverse muscle cutting approach. The aim of this study was to compare the morbidity associated with these 2 operative techniques.

Biochemical severity of thyroid ectopia in congenital hypothyroidism demonstrates sexual dimorphism.

Background: A recent study suggested that sexual dimorphism affects initial thyroid function in congenital hypothyroidism (CH) but differs according to aetiology of CH.

Aims: To determine if sexual dimorphism was associated with biochemical severity of CH and its aetiology in our large British population.

Methods: We examined retrospectively the initial thyroid function tests of 140 infants diagnosed with CH from screening.

Novel 'phage display antibodies identify distinct heparan sulfate domains in developing mammalian lung.

Heparan sulfate proteoglycans (HSPGs) are essential to respiratory morphogenesis in species as diverse as Drosophila and mice; they play a role in the regulation of numerous HS-binding growth factors, e.g. fibroblast growth factors.

Less is best? The impact of urokinase as the first line management of empyema thoracis.

To assess the impact of intrapleural urokinase and small tube thoracostomy on the management of childhood empyema thoracis. The study population included 38 children presenting consecutively to a regional surgical unit with empyema thoracis from January 2001 to December 2003. Children with malignancy, immunodeficiency and complex intercurrent illness were excluded.

Sacrococcygeal teratoma--a 25-year experience in a UK regional center.

Background: Sacrococcygeal teratoma (SCT) is uncommon (1:35,000-1:40,000 newborns). We report a 25-year single-center experience with a focus on late effects.

Methods: Surgical and tumor registries identified patients with SCT between 1977 and 2001.