Zeitschrift für Kinderchirurgie : organ der Deutschen, der Schweizerischen und der Osterreichischen Gesellschaft für Kinderchirurgie = Surgery in infancy and childhood
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A 3 mm metallic particle, which had blasted during grinding operation, shot into the neck of a nine year old boy, penetrated into the common carotid artery and embolized the right middle cerebral artery. There had been no neurological symptoms until four days after the injury. Suddenly, a mild left side hemiparesis occurred with accentuation of the arm. ⋯ Hence, the small particle may not be detected by a local radiogram, or may not be found on surgical exploration. Therefore, in all cases of neck wounds caused by low velocity injection of foreign bodies, radiological evaluation with skull-x-rays and a neurological examination should be done. If further special scans are required, these should be accomplished by axial computer tomography, because the metallic nature of the foreign bodies would prohibit the examination by magnetic resonance.
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The plasma concentrations of lidocaine and prilocaine after dermal application of EMLA cream 5% were determined in two clinical studies. The cream (10-16 g) was applied to a total surface area of 100-160 cm2. Each area was covered by a Tegaderm dressing (3M) in order to obtain occlusion. ⋯ Transient local reactions (paleness, redness) were frequently observed. In one patient with eczema present at the application site prior to the application, a reaction persisted for one week. Dermal analgesia provided by EMLA is a safe and effective method for alleviation of pain from removal of mollusca and the plasma concentrations are innocuous.
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Case Reports
A new technique for the excision of the first branchial cleft fistula--turn-inside-out method of the fistula.
Conventional surgery of the first branchial cleft fistula has been highly complicated. Especially the management of the facial nerve and the complete removal of the fistula in the ear canal side were very difficult. According to the anatomical and embryological studies, we designed a new operative technique. We applied this method successfully in two cases, and we consider it to be very safe, easy and effective.
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Case Reports
Nuclear magnetic resonance computerised tomography (NMR-CT) in early diagnosis of dumbbell neuroblastoma.
This is a report on a dumbbell neuroblastoma with intraspinal extension first noted by 99mTc-HMDP imaging and CT, and confirmed by NMR-CT before the symptoms of spinal cord compression become clear. Paravertebral neuroblastoma and its intraspinal involvement were successfully excised following laminectomy and abdominal surgery without any residual neurologic complications. We report this case to emphasise that NMR-CT was particularly useful to diagnose the extent of intraspinal portion of the tumour, and should be performed in any patient who presents with neuroblastoma adjacent to the vertebral body.
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The different modes of presentation of extradural haematomas in children are discussed, based on the clinical data of 13 patients (12 operated and one conservatively treated). In a 12-month-old infant, anaemia and bradycardia were the first signs of the haematoma, whereas stupor and apnoeic respiration pattern were seen in a 5-year-old boy. Both children had neither pupillary dilatation nor focal neurological signs. ⋯ In two patients who were again deteriorating after 4 and 12 days a second CT scan showed a delayed extradural haematoma. Another patient was referred on the 7th day with a posterior fossa EDH. A small epidural bleeding resolved spontaneously under conservative treatment.(ABSTRACT TRUNCATED AT 250 WORDS)