[Nasal carriage of community-acquired methicillin-resistant Staphylococcus aureus in healthy children from Chengdu]

OBJECTIVE

To evaluate the prevalence of nasal carriage of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in healthy children from Chengdu.

METHODS

Strains of Staphylococcus aureus were isolated from nasal swabs of healthy children from five kindergartens in Chengdu from September, 2005 to December, 2005 and questionnaires were obtained. Antibiotic susceptibility test was performed with agar disk diffusion and Bauer-Kirby on Mueller-Hinton medium method to determine CA-MRSA. mecA and PVL genes were detected with PCR in all of the CA-MRSA isolates.

RESULTS

A total of 801 children were enrolled. Overall 147 children (18.4%) were carried with Staphylococcus aureus and 9 (1.1%) were carried with CA-MRSA. All CA-MRSA isolates were positive for mecA gene, and 5 CA-MRSA isolates were positive for PVL gene. Of the 9 CA-MRSA isolates, 6 were multiresistant.

CONCLUSIONS

CA-MRSA nasal colonization is present among Chengdu healthy children. The CA-MRSA isolates are multiresistant and parts of CA-MRSA isolates carry PVL gene. The nasal carriage of CA-MRSA in healthy children should be a concerned issue.

Parental satisfaction with children's primary dental care in Valencia, Spain

AIM

To evaluate parents' satisfaction with the dental care that their children received in a primary dental care unit in Valencia, Spain.

METHODS

A cross-sectional study was designed. Parents were given a self-administered questionnaire with questions on accessibility, information received from the dentist and hygienist, staff interest in their child, dentist's and hygienist's apparent professional competence, handling of the child's behaviour, cleanliness of the office (surgery), overall parent satisfaction, parent's and child's age, and parental educational level. The chi-square test was used to assess overall parental satisfaction and the other study variables. For the multivariant study, CHAID (CHi-square Automatic Interaction Detection) analysis was used.

RESULTS

Out of a possible 400 respondents, 389 completed the questionnaire, of whom 384 completed it in full. The variables significantly associated with overall parental satisfaction were waiting time before the consultation, cleanliness of the surgery, the manner in which appointments were made, staff attitude with regard to helping, listening and understanding, the dentist's and hygienist's professionalism, handling of the child's behaviour, and information given by the dentist and hygienist. In logistic regression, the aspects that significantly explained parental satisfaction were the professionals' apparent competence, the information given by the dentist, staff interest in their child, and the handling of the child's behaviour.

CONCLUSION

The parents who took part in this study were satisfied with the care that their children received, mainly with aspects related to professional competence and information provided.

Concurrent and predictive validity of the Galician CDI

This paper explores the concurrent and predictive validity of the long and short forms of the Galician version of the MacArthur-Bates CDI (IDHC). Forty-two Galician-speaking children were longitudinally evaluated at age 1 ; 6, 2 ; 0 and 4 ; 0. On the first two occasions, the subjects' vocabulary and grammar skills were assessed through the IDHC. Simultaneously, lexical and grammatical measures were obtained from spontaneous speech samples. Standardized measures of general cognitive abilities (WPPSI-R) and receptive and expressive language (RDLS-III) were obtained at age 4 ; 0. Results showed high and significant levels of concurrent and short-term validity of the IDHC. Strong associations were found between lexical development at age 2 ; 0 and language scores two years later. These results coincide with those obtained with other CDI versions, and suggest that the IDHC is an effective and reliable tool.

Mercury hair concentrations and dietary exposure among Inuit preschool children in Nunavut, Canada

There is concern that the traditional diet is a source of mercury exposure among Inuit in the Canadian Arctic. Mercury exposure in utero and in early childhood presents a risk to neurodevelopment. The objectives of the present study were to assess the dietary mercury exposure from traditional food among Inuit children 3 to 5 years of age in Nunavut, and evaluate the association between estimated dietary mercury intake and body burden. A cross-sectional Nunavut Inuit Child Health Survey was conducted in 2007 and 2008 which included assessment of dietary habits and children's hair mercury (Hg) levels. Further, an Inuit Adult Health Survey was conducted in the same years which included assessment of dietary habits and whole blood mercury concentrations. Traditional food samples were collected during this study and previously from the Canadian Arctic. Daily mercury intake from traditional food was calculated. Body mercury burden was determined using the hair mercury concentration. The geometric mean of children's hair Hg was 0.66 μg/g and varied by region. Nearly 25% of children had hair Hg concentrations equal to or higher than 2 μg/g (WHO reference level). There was a significant correlation between mercury levels in children's hair and that of the adults in the same household. For children, beluga muktuk, narwhal muktuk, ringed seal liver, fish, caribou meat and ringed seal meat were the major dietary sources of mercury. These food items together accounted for over 95% of total daily dietary mercury intake. A positive linear regression relationship between children's hair mercury levels and estimated dietary mercury intake was observed. Estimated intake in Baffin decreased by 30% compared to 20 years ago. Some traditional food items were significant sources of mercury to Inuit children in Nunavut. Although a reduction in the consumption of these diet items may be a way to reduce mercury intake, the nutritional, social and cultural benefits of traditional food and countervailing risks must be taken into account in risk mitigation.

[Constant-infusion technique of inulin clearance without urine collection]

Inulin clearance is accepted as the gold standard for estimating the glomerular filtration rate (GFR). However, the method of this examination is troublesome and infants need difficult bladder catheterization. The existence of residual urine results in an inaccurate estimation of GFR and the proceduse requires a large amount of transfusion. In the plasma infusion method, inulin reaches an equilibrium in which the inulin urinary excretion rate is equal to the infusion rate, and urine collection is unnecessary. We estimated GFR in 21 children using both the plasma infusion method and renal infusion method. In the renal infusion method, the loading infusion of 1% inulin was administered over 30 minutes at the dose of 5 mL/kg body weight, followed by maintenance infusion at the constant speed (mL/hour) of 1.5 x estimated GFR (mL/min/1.73 m2) x body surface area (m2)/ 1.73. Three 30-minute urine collections were performed and the plasma inulin levels were measured to estimate GFR. In the plasma infusion method, maintenance infusion was conducted at the speed (mL/hour) of 0.6 x estimated GFR (mL/min/1.73 m2) x body surface area (m2)/1.73. The mean plasma inulin concentrations at 8, 9 and 10 hours were examined and GFR was calculated with the infusion rate. The GFRs for the renal infusion methods (Cin) and plasma infusion methods (e-Cin) were 91.90 +/- 39.61 and 95.33 +/- 38.08 mL/min/1.73 m2, respectively. The values for Cin and e-Cin showed good linear correlation (R2 = 0.81). The value of e-Cin/Cin was 1.069 +/- 0.172 and the mean e-Cin value was only 7% higher than that of Cin. We believe that GFR estimated by the constant infusion method shows a value approximating that estimated by the standard method. This technique is noninvasive for infants and the GFR of children who have vesicoureteral reflux or residual urine in the bladder can be estimated. The method does not need a large amount of transfusion and is suitable for children with heart failure. We believe that this method is clinically useful.

Monitoring of daily gliadin intake in patients on gluten-free diets

The aim of the study was to show patients suffering from the coeliac disease, their real gliadin daily intake, offer them very useful information concerning their diet and to find random possible mistakes. The monitoring was carried out within the context of their routine everyday diet regimen. The daily intake of gliadin in the diet was quantified on the basis of gliadin determination in their current daily food. The gluten-free diet was followed for 30 days. The patients were taking regular daily meals, drinks, and sometimes medicines or food supplements. The patients were provided with instructions, survey forms, digital scales, polyethylen bottles and sacks. The patients took out the stipulated amount, which served as a sample of each of their daily meals. The samples included both homemade meals as well as commercial products. The content of gliadin in daily meal was determined by the sandwich ELISA method. The daily gliadin intake was calculated on the base of the reported amount of meals ingested. 1,900 food samples were analyzed within the framework of this study. Several contaminated commercial foods were found; nevertheless this fact did not influence the otherwise satisfactory overall picture of the daily gliadin intake by the patients followed. The results in 14 patients revealed a satisfactory adherence to the gluten-free diet. It was proved that conscientiousness and awareness on the part of coeliac patients, or those taking care of them, is of paramount importance in determining the choice of foods comprising a gluten-free diet.

[Studies on HCV infection prevalence in Poland--where are we?]

Numerous studies conducted in HCV infection over the past several years in Poland have focused on clinical course, treatment and epidemiology in selected high risk groups. Studies estimating the prevalence of HCV in the current general population are lacking. Various studies conducted in subpopulations yielding values ranging from 0.9% to over 4%. In the present paper we attempt to explain these discrepancies and assess the reliability of available data. We included prevalence studies published in 2000-2009, which could refer to the general adult population in Poland. All available studies in terms of possible conclusion about the general population suffered from systematic errors, most commonly selection bias (e.g., volunteer bias, hospital bias), or misclassification (no confirmation of detected anti-HCV). Given estimates often referred only to selected regions or age groups. Extrapolating these results to estimate the burden of illness in general population may lead to incorrect assessment, thus currently there is no scientific basis for planning screening programs and national strategies against HCV.

[Therapeutic difficulties in a 3 year-old boy with Kawasaki disease]

A case of a three year-old by with delayed diagnosis of disease is presented. Treatment with immunoglobulins and methylpreduisolone was affective, however, no regression in coronary artery lesions was observed. The diagnosis and treatment of Kawasaki disease are discussed.

Percutaneous nephrolithotomy complications in 671 consecutive patients: a single-center experience

PURPOSE

To evaluate major and minor complications of percutaneous nephrolithotomy (PCNL) and their management in our consecutive cases.

MATERIALS AND METHODS

We reviewed medical records of 671 patients who had undergone PCNL in our center from March 2000 to March 2006. The demographic data, stone parameters, PCNL complications, and stone-free rate were evaluated. Multiple parameters were evaluated for their association with PCNL complications using Chi-Square test.

RESULTS

Complications occurred in 203 (30.3%) patients; renal parenchymal injury in 103 (15.4%), peri-operative bleeding in 42 (6.3%), late bleeding in 6 (0.9%), renal collecting ducts injury in 35 (5.2%), fever in 7 (1.0%), colon perforation in 2 (0.3%), major vessels injury in 3 (0.4%), pneumothorax in 3 (0.4%), and hemothorax in 2 (0.3%) subjects. Mortality occurred in 1 patient with colon perforation (0.15%).

CONCLUSION

Percutaneous nephrolithotomy has low complication rate in experienced hands.

[Bicycle spoke-related injuries in children: emphasise prevention]

Three children, a 6-year-old boy and two girls aged 5 and 4 years, were seen at an emergency department due to distal lower-leg injuries sustained from the spokes of bicycle wheels. All three patients had been passengers on rear carrying seats of moving bicycles. Only the third bicyclist had used a special child safety seat. The second girl had drawn her foot up from underneath a strap and suffered a tibial fracture later treated with an osteosynthetic plate. The other two patients recovered after conservative casting treatment. Bicycle spoke-related injuries are sustained when the foot or lower limb makes contact with the spokes of a bicycle wheel and usually by children who are bicycle passengers. In the Netherlands, approximately 4600 children are seen at emergency departments with such injuries each year. Bicycle spoke-related accidents can cause severe damage that can result in lengthy recovery periods. Not only physical complications but also psychological ones can occur. The latter are often overlooked but do deserve proper treatment. The physician treating a spoke-related injury is in a good position to advice parents as to preventive measures, particularly on the use of special child safety seats.

Undernutrition status of children under 5 years in Chinese rural areas - data from the National Rural Children Growth Standard Survey, 2006

PURPOSE

To assess the nutritional status among rural children under five years in China relative to WHO Child Growth Standards 2006, and to explore risk factors for undernutrition.

DESIGN

Cross-sectional study of rural areas in 10 provinces of China. A total of 84,009 children under five recruited through multi-level sampling.

MAIN FINDINGS

A total of 17.92% of children have at least one form of undernutrition. The prevalence of stunting, underweight and wasting, were 14.59%, 7.19% and 3.07%, respectively. The corresponding mean z-score in height-for-age, weight-for-age, and weight-for-height were -0.732, -0.410 and -0.001. An upward trend with age in stunting and underweight was observed, and higher risks noticed among older children in contrast with children under 6 months in terms of stunning and underweight. The inter-provincial variation of undernutrition remains very large. Low birth weight, multi parity, preterm birth, multiple birth, maternal illiteracy, low provincial GDP, and low household income are identified as significant factors associated with stunting. Parity shows no corresponding significant relationship with underweight, and wasting was not found to be associated with either preterm or multiple births.

CONCLUSION

The nutritional status among children under five in rural areas of China, although greatly improved in the past decades, still lags behind the WHO Child Growth Standards. Stunting and underweight occur mostly before two years of age. Intervention strategies and programs should be developed to target the preventable risk factors.

[Estimation of carbon monoxide poisonings frequency, based on carboxyhemoglobin determinations performed in Toxicology Laboratory in Krakow in years 2002-2010]

Carboxyhemoglobin is a specific biomarker of carbon monoxide (CO) exposition. The source of CO indoors are most often gas, oil or carbon furnaces and stoves or bathroom gas heaters. CO intoxication during fire or exposition to car fumes are sporadic. The aim of the study was: to present the frequency of CO intoxications diagnosed in Laboratory of Analytical Toxicology UJ Collegium Medicum in years 2002 - 2010, to present the season trends of CO intoxications, show sex and age structure of CO intoxicated patients. Material were Laboratory of Analytical Toxicology and Drug Monitoring data records from years 2002 - 2010. CO intoxication was confirmed and recognized when COHb blood concentration was higher than 10%. Annual number of CO poisonings was stable in the period of time, varied from 209 to 296 (mean 256,2 CO poisonings per year). Sex structure of CO poisoned patients showed little female dominance (54.6%). Carbon monoxide poisonings distribution was seasonal. The season of intensified CO intoxications lasted from October to March, the highest intensity was in December and January. The CO poisoning problem is still actual. Society education about security, recognition, diagnosis and practice in carbon monoxide exposition is still needful.

Hyphema revealing retinoblastoma in childhood. A case report

We present a case dealing with an uncommon presentation of retinoblastoma. An 4-year-old boy presented to the ophthalmic department for a red painful eye following trauma. The examination showed decreased visual acuity, total hyphema and ocular hypertony. Ocular ultrasonography revealed an intraocular process. CT-scan of the orbit was consistent with a retinoblastoma. Treatment consisted of an enucleation and chemotherapy. This paper stresses the fact that presentation of retinoblastoma is not stereotypic. Every effort should be made to exclude a tumoral intraocular process in all cases of hyphema, even in cases of well documented ocular trauma.

Hodgkin lymphoma in Pakistan: an analysis of subtypes and their correlation with Epstein Barr virus

The epidemiology of Hodgkin lymphoma (HL) shows a wide geographic variation with regard to age, gender, histological subtypes and their association with Epstein-Barr virus. The proportion of EBV positive cases appears higher in developing than in developed countries. EBV is a common infection in Pakistan due to poor socioeconomic conditions, but reports regarding HL subtypes have been rather selective. Our aims were to establish the relative frequencies of the five subtypes of Hodgkin lymphoma, to determine their associations with Epstein-Barr virus, and finally to establish whether such association follows patterns seen in developing or developed countries. Among 100 cases, the male: female ratio was 4.5:1, with an age range of 4-82 years and an average of 26.6 years. Similar to the subtype distribution in developing countries, mixed cellularity was the commonest 57%, followed by nodular sclerosis 35%, lymphocyte rich 6% and nodular lymphocyte predominant 2%. EBV-LMP1 staining was demonstrated in 41/57 (71%) of the mixed cellularity and the 19/35 (54.2%) of nodular sclerosis subtypes. All 6 cases of lymphocyte rich and 2 cases of nodular lymphocyte predominant were negative for EBV-LMP 1. Speculation about prognostic effects of EBV infection on the course of HL are tempting. Thus the EBV-positive HL could in the future prove to be an excellent candidate for targeted cellular immunotherapy.

Cancer incidence in Oman, 1998-2006

BACKGROUND

This paper gives a profile of the cancer incidence in Oman for a nine-year period from 1998-2006.

METHODS

Data from the population-based national cancer registry were consolidated for the said nine-year period and analyzed. A breakdown of the incidence by year and gender have been given. Age-standardized incidence of common cancers in Oman and their age-specific rates have been tabulated. Further, a graphical comparison between common cancers in Omani men and women have been made with those of other Gulf countries and some developed countries.

RESULTS

There were a total of 8,005 (4,224 males and 3,781 females) cases reported and registered in the registry from January 1998 till December 2006 with a male female ratio of 1.1:1. The crude incidence rate was 49.4 per 100,000 males and 45.7 per 100,000 females. The corresponding age-standardized rates were 91.4 and 80.4 per 100,000 in males and females respectively.

CONCLUSIONS

Incidence of cancer in Oman is lower than in some Gulf countries and many developed countries. Stomach cancer, non-Hodgkin lymphoma and leukemia are three commonest cancers in males and breast, thyroid and cervical cancers are the most common in females in the nine-year period.

Family structure and child health outcomes in the United States

We use categorical and logistic regression models to investigate the extent that family structure affects children’s health outcomes at age five (i.e., child’s type of health insurance coverage, the use of a routine medical doctor, and report of being in excellent health) using a sample of 4,898 children from the "Fragile Families and Child Well-Being Study." We find that children with married biological parents are most likely to have private health insurance compared with each of three other relationship statuses. With each additional child in the home, a child is less likely to have private insurance compared with no insurance and Medicaid insurance. Children with cohabiting biological parents are less likely to have a routine doctor compared with children of married biological parents, yet having additional children in the household is not associated with having a routine doctor. Children with biological parents who are not romantically involved and those with additional children in the household are less likely to be in excellent health, all else being equal.

[Efficacy of reamberin in treating heavy acute intestinal infection in children]

The current health conditions dictate the need to reduce the time of patient treatment in hospital and require rational use of drugs. Reduction of the duration of intoxication syndrome in severe forms of intestinal infections in children depends on infusion therapy and choice of solutions for intravenous administration. Reamberin is generation IV infusion preparation for intensive care, representing a balanced isotonic detoxicant infusion solution based on succinic acid. Using reamberin ensures a significant decrease in the time of stay in hospital for children with severe forms of intestinal infections, which is achieved by reducing the duration of endogenous intoxication.

Developmental pharmacokinetics

The advances in developmental pharmacokinetics during the past decade reside with an enhanced understanding of the influence of growth and development on drug absorption, distribution, metabolism, and excretion (ADME). However, significant information gaps remain with respect to our ability to characterize the impact of ontogeny on the activity of important drug metabolizing enzymes, transporters, and other targets. The ultimate goal of rational drug therapy in neonates, infants, children, and adolescents resides with the ability to individualize it based on known developmental differences in drug disposition and action. The clinical challenge in achieving this is accounting for the variability in all of the contravening factors that influence pharmacokinetics and pharmacodynamics (e.g., genetic variants of ADME genes, different disease phenotypes, disease progression, and concomitant treatment). Application of novel technologies in the fields of pharmacometrics (e.g., in silico simulation of exposure-response relationships; disease progression modeling), pharmacogenomics and biomarker development (e.g., creation of pharmacodynamic surrogate endpoints suitable for pediatric use) are increasingly making integrated approaches for developmentally appropriate dose regimen selection possible.

Observed magnetic resonance imaging changes in pediatric patients treated with stereotactic radiosurgery for intracranial tumors

PURPOSE

This study seeks to characterize magnetic resonance imaging (MRI) changes following stereotactic radiosurgery (SRS) of pediatric brain malignancies.

METHODS

Serial MRI evaluations were performed on 21 lesions treated with SRS for either medulloblastoma (n=12), juvenile pilocytic astrocytoma (n=4), ependymoma (n=2), atypical rhabdoid teratoid tumor (n=2), or pineocytoma (n=1). Prescription doses ranged from 14 to 30 Gy in one to five fractions. Tumor response was qualified as complete (CR), partial (PR), stable disease (SD), or progressive disease (PD) according to the RECIST v1.1. Median radiographic follow-up after SRS was 17 months.

RESULTS

A total of 80 follow-up MRI scans were reviewed with a median of eight per patient. During serial MRI evaluation, eight lesions met criteria for PD at a median of 6 months. However, of these, three (37%) represented transient tumor edema with two lesions later developing a CR at a median of 15 months and one persisting as SD at 12 months. The remaining five lesions were true local failures. Of the 13 lesions that did not show evidence of PD, a CR was obtained in 11 lesions at a median of 3 months (range, 2-6), and SD was seen in the remaining two tumors at last follow-up.

CONCLUSION

Lesion enlargement following SRS for pediatric intracranial tumors is common, and a proportion of patients meeting requirements for PD at early radiographic follow-up may later develop complete resolution of their lesions. Physicians should be aware of these radiographic changes to avoid unwarranted medical and surgical interventions.

Autistic disorder and phospholipids: A review

Dysregulated phospholipid metabolism has been proposed as an underlying biological component of neurodevelopmental disorders such as autistic disorder (AD) and attention-deficit/hyperactivity disorder (ADHD). This review provides an overview of fatty acid and phospholipid metabolism and evidence for phospholipid dysregulation with reference to the membrane hypothesis of schizophrenia. While there is evidence that phospholipid metabolism is at least impaired in individuals with AD, it has not been established whether phospholipid metabolism is implicated in causal, mechanistic or epiphenomenological models. More research is needed to ascertain whether breastfeeding, and specifically, the administration of colostrum or an adequate substitute can play a preventative role by supplying the neonate with essential fatty acids (EFAs) at a critical juncture in their development. Regarding treatment, further clinical trials of EFA supplementation are essential to determine the efficacy of EFAs in reducing AD symptomatology and whether supplementation can serve as a cost-effective and readily available intervention.

Putting two and two together? Early childhood education, mothers’ employment and care service expansion in Chile and Mexico

In recent years, several middle-income countries, including Chile, Mexico and Uruguay, have increased the availability of early childhood education and care (ECEC) services. These developments have received little scholarly attention so far, resulting in the (surely unintended) impression that Latin American social policy is tied to a familialist track, when in reality national and regional trends are more varied and complex. This article looks at recent efforts to expand ECEC services in Chile and Mexico. In spite of similar concerns over low female labour force participation and child welfare, the approaches of the two countries to service expansion have differed significantly. While the Mexican programme aims to kick-start and subsidize home- and community-based care provision, with a training component for childminders, the Chilean programme emphasizes the expansion of professional ECEC services provided in public institutions. By comparing the two programmes, this article shows that differences in policy design have important implications in terms of the opportunities the programmes are able to create for women and children from low-income families, and in terms of the programmes’ impacts on gender and class inequalities. It also ventures some hypotheses about why the two countries may have chosen such different routes.

[Thoracal insufficiency syndrome in congenital scoliosis]

We analyzed literature data and our own experience with treatment of 180 patients under 7 years of age during the period of 1990-2010. To demonstrate the resources of surgical correction of spinal and thoracic deformities in children with severe deformities of the spinal column and thoracic cage we propose a rational strategy of operative correction and postoperative management for children of early age depending on the variations of malformation.

Childhood cancer incidence and survival 2003-2005, Thailand: study from the Thai Pediatric Oncology Group

BACKGROUND

Previous population-based incidences of childhood cancer in Thailand were achieved by extrapolating from data limited to a small number of cancer registries, not from the whole country. In addition, survival of childhood cancer patients is often described in specialized hospitals and/or institutions, but not in the general population.

METHODS

All children aged 0-15 years who were newly diagnosed as having cancer were registered from 18 treatment centers during 2003-5 and classified into 12 diagnostic groups according to the International Classification of Childhood Cancer. Incidences were calculated by a standard method and survival was investigated using the ThaiPOG (Thai Pediatric Oncology Group) population-based registration data. Overall survival was calculated by the Kaplan Meier method.

RESULTS

In the study period (2003-5) 2,792 newly diagnosed cases of childhood cancer were registered, with mean and median ages of 6.5 (SD=0.13) and 5.0 (0-14) years, respectively. The age-peak was between 1 and 4 years and the age-standardized rate (ASR) was 74.9 per million. Leukemia was the most common cancer (N=1421, ASR 38.1) followed by lymphoma (N=266, ASR 6.4) and neoplasms of the central nervous system (CNS, N=246, ASR 6.3). The follow-up duration totaled 101,250 months. The death rate was 1.11 per 100 person-months (95%CI: 1.02 -1.20). The 5-year overall survival was 54.9% (95%CI: 53.0%-56.9%) for all cancers. The respective, 5-year overall survival for (1) acute lymphoblastic leukemia (ALL), (2) acute non-lymphoblastic leukemia (ANLL), (3) lymphoma, (4) retinoblastoma, (5) renal tumors, (6) liver tumors, (7) germ cell tumors, (8) CNS tumors, (9) neuroblastoma, (10) soft tissue tumors and (11) bone tumors were (1) 64.5%, (2) 35.1%, (3) 59.5%, (4) 73.1%, (5) 70.4%, (6) 44.5%, (7) 70.6%, (8) 41.7%, (9) 33.6%, (10) 50.1%, and (11) 33.7%.

CONCLUSIONS

The incidence of childhood cancer is lower than in western countries. Respective overall survival for ALL, lymphoma, renal tumors, liver tumors, retinoblastoma, soft tissue tumors is lower than those reported in developed countries while for CNS tumors, neuroblastoma and germ cell tumors the figures are comparable.

Survey-based cancer mortality in the Lao PDR, 2007-08

BACKGROUND

The Lao PDR is a landlocked country with 5,920,000 inhabitants for which very few epidemiological studies on cancer have been performed. The aim of the present study was to examine cancer mortality in 2007-2008.

METHODS

A descriptive cancer epidemiology protocol was designed with a data collection form and guideline for both demographics and list of all deaths from all 757 local Health Centers of 17 provinces/ cities. Five indicators, name, age, sex, date of death and the cause of death (ICD-10), were collected for each case. The age-specific cancer mortality rate and ASRs per 100,000 were estimated.

RESULTS

There were 448 cancer cases reported from Health Centers within 7 of 17 provinces/cities. Number of person-years was 654,459 for the two-year period. Cancer mortality rates of all sites (ASR) were 116.7 and 97.2 per 100,000 in males and females, respectively. The five most common cancers causing mortality per 100,000 were liver (52.2), followed by colorectal (19.0), lung (17.3), stomach (6.9), and leukemia-lymphoma (7.2) in males and liver (28.4); followed by colorectal (19.0), lung (14.0), cervical uteri (9.2) and stomach (7.1) in females.

CONCLUSIONS

Liver and colorectal cancers were the first and second most common, respectively, in both males and female.

MRI criteria of developmental lumbar spinal stenosis revisited

PURPOSE

It is somewhat surprising that radiographic criteria for lumbar stenosis have been transposed from radiography and CT to MR without scientific validation. As these radiographic criteria were developed via population studies with criteria defined by two standard deviations from the mean, we sought to perform the same methodology via MR.

METHODS

The study was approved by the institutional review board; the requirement for informed consent was waived. One-hundred patients referred for possible metastatic disease, aged 4 to 94 were studied. Measurements were obtained on a midline sagittal T2-weighted (6000/120) image at each disc level, as well as at the mid-vertebral level. The distributive mean, and standard deviations were calculated and -2 SD was used as a "cutoff" for spinal stenosis. To assess for interobserver variation, 20% of the measurements were repeated by a second observer. To assess for intraobserver variation, another 20% of the measurements were repeated a second time at a minimum of a two month interval.

RESULTS

The spinal canal was narrowest at L5-S1 (mean: 1.16 cm), and widest at L1-L2 (mean: 1.56 cm). Overall the narrowest measurements were at the intervertebral disc space and were narrower at the lower disc spaces. In our population, the lowest cutoff limit (two standard deviations below the mean) had a range between 0.38 cm at the L3-L4 disc space and 0.9 cm at the L1 vertebral level. Notably at the L3 level the size range was from 0.77 to 1.75

CONCLUSION

Traditional measurements of canal diameters may be too large when applied to soft tissue analysis on MR. We suggest using a cutoff of smaller than 0.90 cm for developmental stenosis.

[Progress on the Millenium Development Goals 4 and 5 in Mesoamerica]

OBJECTIVES

To describe the advances made by countries in the Mesoamerican region towards reaching Millenium Development Goals (MDG) 4 and 5, and discuss the most useful tasks to help the region in accomplishing or keeping track of these objectives.

MATERIAL AND METHODS

The trend estimates of maternal and under 5 mortality from 1990 to 2008, the effective coverage of vaccination against diphteria, pertussis and tetanus (DPT), prenatal care and childbirth by qualified personnel were taken from the Institute of Health Metrics and Evaluation (IHME) and the causes of death for children under five were taken from the Children's Health Epidemiology Reference Group of WHO (CHERG).

RESULTS

The regional trend in the rate of mortality for children under five (MDG-4) in the last 18 years shows an annual reduction of 4.2%, significantly above the global reduction of 2.1%. This suggests that countries of Mesoamerica will be able to fulfill this objective. In contrast, data for 2008 shows that the rate of reduction of maternal mortality is very heterogeneous and it is unlikely that any of the countries in the region will reach this goal.

CONCLUSION

Efforts made by countries in Mesoamerica have been substantial in controlling mortality in children under five years but insufficient to achieve MDG-5. Although the tendency is in the right track the reduction rate will only partially fulfill the acquired commitments to eradicate poverty.

A prospective study of cefepime versus ticarcilline/clavulanate as empirical treatment of febrile neutropenia in lymphoma patients

OBJECTIVE

To check the effectiveness of ticarcillin clavulanate versus cefepime as monotherapy in febrile neutropenia in lymphoma patients and also to check tolerability profile of both drugs.

METHODS

We randomly assigned 107 neutropenic patients to receive either cefepime or ticarcillin/clavulanate. The clinical efficacy and tolerability profile of both drugs were compared using either cefepime or ticarcillin clavulanate (TC) as an empirical treatment for management of febrile neutropenia in lymphoma patients only with same characteristics at time of presentation.

RESULTS

A significant difference in efficacy of the two treatment arms was noted. A successful outcome was reported with 28 (51%) out of 55 in cefepime arm compared to 16 (42%) out of 52 patients in ticarcillin/clavulanate group (p = 0.35; 95% Confidence). The distribution of time for defervesence was estimated for each treatment group and a trend to a shorter time for defervesence was found in the CEFEPIME group (48.4 hour for cefepime, 58.28 hour for TC group; p = 0.018). For microbiologically documented infections, the successful eradication rate was 49% (6 of 14 patients) for TC group as compared to 83% (10 of 12 patients) for cefepime group. This difference was statistically significant for microbiologically documented infections. Twenty seven (52%) patients of TC group and 19 (35%) of cefepime group required modifications of antibiotic regimen. The most frequent modifications consisted of the addition of either an amino glycoside (amikacin) or glycopeptides (vancomycin).

CONCLUSION

CEFEPIME regimen was more effective than TC regimen, with a consistent trend toward a better outcome associated with cefepime compared to Ticarcillin/clavulanate.

Living donor kidney transplantation at the University of Michigan

Since renal transplantation is the definitive therapy for most patients with end stage renal disease, we have the challenge of meeting the needs of this rapidly growing population. Currently greater than 1000 patients are waiting for kidney transplantation at the University of Michigan. To meet this demand we have aggressively expanded the donor pool from both deceased and living donors. The focus of this update has been the evolving living donor program at the University of Michigan. In light of the rising rates of obesity in America, we have developed a specialized evaluation to assess potential obese donors. Individuals with a history of hypertension and no other risk factors for kidney failure are screened according to a protocol seeking to identify patients with a low risk of developing chronic kidney disease. We have developed unique approaches to patients with anatomic anomalies as well as nephrolithiasis. Despite all of these progressive approaches, our living donor outcomes at the University of Michigan have remained excellent and we have continued to provide a high standard of care for our recipients suffering from end stage renal disease.

[The analysis of the clinical symptoms and social conditionings of the tic disorder in children]

A tic is a rapid, involuntary and stereotypical motor movement or vocalization. The exact cause of tic disorder is unknown, but it is well established that both genetic and environmental factors are involved. Tic occurence in population was estimated on 5-100/10 000.

AIM

The purpose of the research was to analyze the clinical symptoms and social conditionings of tic disorder in children.

MATERIAL AND METHOD

The analysis was conducted on a group of 42 patients (8 girls, 34 boys) at the age of 3 to 15 years, admitted to Department of Neuropediatric of Medical University of Silesia to diagnose and treatment of tic disorder. The children's family history was analyzed. The patients were physically, neurogically, radiologically and psychologically examined.

RESULTS

The majority group were boys and the time of the symptoms appearance was an early school age. The tics were associated with emotional and anxiety disorders, compulsive behavior, psychological obsession. 9% of patients had family history of tic disorder. Pregnancy-birth history was complicated in 24% of cases. There were not abnormalities in physical, neurological and radiological examination in most cases. The majority group (83%) lives in the cities. The most parents have vocational training.

CONCLUSION

In case of appearance of twitching during suspicious behavior of child, we need to carry out a inquiring research targeted to widely understated social issues.

Impact of a community-based exercise program on children and adolescents with disabilities

The purpose of this study was to determine if participation in a community-based fitness program improves: a) strength and endurance, b) self-concept and quality of life, and c) positive social interactions among participants with disabilities. Nineteen children completed the study (10 experimental group, 9 control group). Pre/post testing included body mass index (BMI), energy expenditure index (EEI), Presidential Fitness Test (PFT), strength testing using a handheld dynamometer, PedsQL, and the Piers-Harris 2 Self-Concept Scale (PH-2). The experimental group participated in an 8-week exercise program two times per week and were given a home exercise program (HEP). No statistically significant differences were observed in BMI, EEI, PFT, strength, quality of life, or self-concept. A statistically significant difference in social interactions was found between the first and second half of the exercise program while the children performed group activities and ran track based on repeated measures MANOVA at p<0.05. While changes in fitness may not be observed following an 8-week exercise program, improvements in social interactions may be possible.

[Very severe hepatic trauma in childhood. The report of two cases with minimally invasive treatment]

Liver trauma in children is a pathology that has an increasing incidence mainly due to the implications of growing children in hazardous games and sports adventure, and the frequent car accidents. There has been a shift of management in haemodynamically stable patients towards non-operative management. This allows in most cases a patient's complete recovery without surgical aggression, preventing further damage derived from the handling of the injured liver. Herewith we report two cases of a 6 and 4 year old boys who suffered a very severe traumatic rupture of the liver. They were operated through minimally invasive surgical procedures, achieving complete resolution of the serious damages.

The determinants of daily function in children with cerebral palsy

The aim of this study was to identify determinants of daily function in a population-based sample of children with cerebral palsy (CP). The study took into consideration factors from the entire scope of the International Classification of Functioning, Disability, and Health (ICF). Furthermore, the determinants of daily function were examined from the perspectives of capacity and performance respectively. A total of 216 children with CP (mean age 8.19 years, SD 3.39 years) and their caregivers participated in the study. The potential determinants of daily function from the dimensions of health condition, body functions and structures, environmental and personal factors of the ICF were collected. Stepwise multiple regression models showed that child's age, grade, preferred hand, educational placement, severity of gross and fine motor impairment, and prosocial behavior were important determinants, accounting for 88.29% of the variance of daily capacity. The aforementioned variables together with birth order were determinants of performance of daily function, and accounted for 89.53% of the variance in that performance. Knowledge of determinants of daily function helps clinicians and educators to plan intervention and educational programs targeted at these determinants to improve capacity and performance in daily function for children with CP.

Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database

BACKGROUND

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a major health concern in Caucasians. Although the incidence of VTE is generally known to be lower in Asians than in Caucasians, results of epidemiologic studies among Asians have been conflicting. In this study we performed a nationwide population-based epidemiologic study to provide basic information regarding the incidence of VTE in the Korean population.

METHODS

Using the Korean Health Insurance Review and Assessment Service (HIRA) database, VTE patients from 2004 to 2008 were retrospectively identified by both diagnostic codes and medication codes for drugs used in initial treatment of VTE.

RESULTS

The respective age- and sex-adjusted annual incidences of VTE, DVT and PE per 100,000 individuals increased significantly from 8.83, 3.91 and 3.74 in 2004 to 13.8, 5.31 and 7.01 in 2008 (P = 0.0001), with successive increments each year. All three annual incidences also increased steadily with age (P = 0.0001 for all), particularly among those over 60 years old.

CONCLUSIONS

This represents the largest epidemiologic study that demonstrates a lower incidence of VTE in Asian compared with Western populations; however, it also demonstrates a yearly increasing incidence of VTE in the Korean population.

Association between childhood obesity and subsequent Type 1 diabetes: a systematic review and meta-analysis

AIMS

To review and synthesize the published evidence on the possible association between childhood obesity and the subsequent risk of Type 1 diabetes.

METHODS

The PubMed database was systematically searched for studies using childhood obesity, BMI or %weight-for-height as the exposure variable and subsequent Type 1 diabetes as the outcome. Studies were only included if assessment of obesity preceded the diagnosis of Type 1 diabetes.

RESULTS

Eight case-control studies and one cohort study were included, comprising a total of 2658 cases. Of these nine studies, seven reported a significant association between childhood obesity, BMI or %weight-for-height and increased risk for Type 1 diabetes. Meta-analysis of the four studies that reported childhood obesity as a categorical exposure produced a pooled odds ratio of 2.03 (95% CI 1.46-2.80) for subsequent Type 1 diabetes; however, in those studies, age at obesity assessment varied from age 1 to 12 years. A dose-response relationship was supported by a continuous association between childhood BMI and subsequent Type 1 diabetes in a meta-analysis of five studies (pooled odds ratio 1.25 (95%CI 1.04-1.51) per 1 sd higher BMI).

CONCLUSION

There is overall evidence for an association between childhood obesity, or higher BMI, and increased risk of subsequent Type 1 diabetes. Several theories have been proposed for a causal relationship. Reduction in Type 1 diabetes should be considered as a potential additional benefit of preventing childhood obesity.

Hospitalization of Cuban children for giardiasis: a retrospective study in a paediatric hospital in Havana

The medical records of the 185 children who, in 2007, were admitted to the Academic Paediatric Hospital 'Centro Habana', in the Cuban capital of Havana, because of giardiasis were analysed retrospectively. A standardized form was used to collect data on the socio-demographic characteristics, clinical features, laboratory diagnosis, treatment and length of stay of each child. Information on the 15 children who had incomplete medical records was excluded from the data analysis. Of the remaining 170 children, 85 (50·0%) were aged 1-4 years, 97 (57·1%) were male, and 106 (62·4%), 92 (54·1%) and 69 (40·6%) had presented with diarrhoea, vomiting, and/or abdominal pain, respectively. Most (91·2%) of the cases had been diagnosed by the microscopical examination of a duodenal aspirate, and the drugs that had been most used frequently were quinacrine and tinidazole, which had been given to 72 (42·4%) and 62 (36·5%) of the cases, respectively. The mean length of hospital stay was 4·9 days. Such information on the clinical characteristics of giardiasis among children living in an endemic area may be valuable to paediatricians and public-health officials who wish to screen for the disease.

The risk of pedestrian injury and fatality in collisions with motor vehicles, a social ecological study of state routes and city streets in King County, Washington

This study examined the correlates of injury severity using police records of pedestrian-motor-vehicle collisions on state routes and city streets in King County, Washington. Levels of influence on collision outcome considered (1) the characteristics of individual pedestrians and drivers and their actions; (2) the road environment; and (3) the neighborhood environment. Binary logistic regressions served to estimate the risk of a pedestrian being severely injured or dying versus suffering minor or no injury. Significant individual-level influences on injury severity were confirmed for both types of roads: pedestrians being older or younger; the vehicle moving straight on the roadway. New variables associated with increased risk of severe injury or death included: having more than two pedestrians involved in a collision; and on city streets, the driver being inebriated. Road intersection design was significant only in the state route models, with pedestrians crossing at intersections without signals increasing the risk of being injured or dying. Adjusting for pedestrians' and drivers' characteristics and actions, neighborhood medium home values and higher residential densities increased the risk of injury or death. No other road or neighborhood environment variable remained significant, suggesting that pedestrians were not safer in areas with high pedestrian activity.

25-hydroxyvitamin D, insulin-like growth factor-I, and bone mineral accrual during growth

CONTEXT

The extent to which 25-hydroxyvitamin D [25(OH)D] and IGF-I influence bone mineral content (BMC) accrual from early to mid-puberty is unclear. OBJECTIVE, SETTING, AND PARTICIPANTS: This study sought to determine relationships among 25(OH)D, IGF-I, and BMC in community-dwelling prepubertal females (n = 76; aged 4-8 yr at baseline) over a period of up to 9 yr.

DESIGN

The hypothesis that changes in IGF-I vs. 25(OH)D are more strongly associated with BMC accrual was formulated after data collection. 25(OH)D and IGF-I were log-transformed and further adjusted using two-way ANOVA for differences in season and race. Linear mixed modeling (including a random subject-specific intercept and a random subject-specific slope on age) was employed to analyze the proportion of variance the transformed 25(OH)D and IGF-I variables explained for the bone outcomes.

RESULTS

IGF-I was more strongly associated with BMC accrual than 25(OH)D at the total body (R(2) = 0.874 vs. 0.809), proximal femur (R(2) = 0.847 vs. 0.771), radius (R(2) = 0.812 vs. 0.759), and lumbar spine (R(2) = 0.759 vs. 0.698). The rate of BMC accrual was positively associated with changes in IGF-I but negatively associated with 25(OH)D. When IGF-I and 25(OH)D were included in the same regression equation, 25(OH)D did not have a significant predictive effect on BMC accrual above and beyond that of IGF-I.

CONCLUSIONS

These prospective data in early adolescent females indicate that both 25(OH)D and IGF-I have a significant impact on bone mineral accrual; however, the positive association of IGF-I and BMC accrual is greater than the negative association of 25(OH)D and BMC accrual.

[Influenza in Poland in 2009]

A total number of 1,081,974 cases of influenza and influenza-like illness were registered in Poland in 2009 (incidence 2,835.9 per 100,000 population). It was nearly 5 times more than in 2008. The impact on increase of the number of reported cases have had two factors: the pandemic of influenza caused by virus A(H1N1)v, and increasing of the surveillance sensitivity. 3,177 (0.29%) cases was laboratory confirmed. In the area of particular regions incidence ranged from 805.2 in świetokrzyskie voivodeship to 5,257.9 in warmifisko-mazurskie voivodeship. Nearly 37% of cases were children under 15 years. The incidence in this age group was 6,851.2 (from 2,010.1 in Swietokrzyskie voivodeship, to 13,291.6 in warmińsko-mazurskie voivodeship). The highest reported incidence was observed in age group 5-14 years (7,135.2). To hospitals, mainly for epidemiological reasons, 8,944 people were sent (0.83% all cases). According to Central Statistical Office data, there were 87 death cases, including 8 (9.2%) children in the age of 15. 70.1% of deaths were registered as cases caused by identified influenza virus.

Oral health activities of early head start teachers directed toward children and parents

OBJECTIVES

This cross-sectional study examined Early Head Start (EHS) teachers' oral health program activities and their association with teacher and program characteristics.

METHODS

Self-completed questionnaires were distributed to the staff in all EHS programs in North Carolina. Variables for dental health activities for parents (four items) and children (four items) were constructed as the sum of responses to a 0-4 Likert-type scale (never to very frequently). Ordinary least squares regression models examined the association between teachers' oral health program activities and modifiable teacher (oral health knowledge, values, self-efficacy, dental health training, perceived barriers to dental activities) and program (director and health coordinator knowledge and perceived barriers to dental activities) characteristics.

RESULTS

Teachers in the parent (n=260) and child (n=231) analyses were a subset of the 485 staff respondents (98 percent response rate). Teachers engaged in child oral health activities (range = 0-16; mean = 9.0) more frequently than parent activities (range = 0-16; mean = 6.9). Teachers' oral health values, perceived oral health self-efficacy, dental training, and director and health coordinator knowledge were positively associated with oral health activities (P < 0.05). Perceived barriers were negatively associated with child activities (P < 0.05).

CONCLUSION

The level of oral health activity in EHS programs is less than optimal. Several characteristics of EHS staff were identified that can be targeted with education interventions. Evidence for effectiveness of EHS interventions needs to be strengthened, but results of this survey provide encouraging findings about the potential effects of teacher training on their oral health practices.

Enhancing sequential time perception and storytelling ability of deaf and hard of hearing children

A 3-month intervention was conducted to enhance the sequential time perception and storytelling ability of young children with hearing loss. The children were trained to arrange pictorial episodes of temporal scripts and tell the stories they created. Participants (N = 34, aged 4-7 years) were divided into 2 groups based on whether their spoken-language gap was more or less than 1 year compared to age norms. They completed A. Kaufman and N. Kaufman's (1983) picture series subtest and Guralnik's (1982) storytelling test at pretest and posttest. Measures demonstrated significant improvement in sequential time and storytelling achievement postintervention. Three of the examined demographic variables revealed correlations: Participants with genetic etiology showed greater improvement in time sequencing and storytelling than participants with unknown etiology; early onset of treatment correlated with better achievement in time sequencing; cochlear implant users showed greater storytelling improvement than hearing aid users.

Post-arrival screening for malaria in asymptomatic refugees using real-time PCR

Malaria is a significant health risk to refugee populations originating from endemic areas, but there is little consensus on screening and/or treatment approaches for malaria in this population. Furthermore, detection of malaria in semi-immune asymptomatic refugees is limited by the sensitivity of diagnostic tests used for screening. We determined the prevalence of malaria by microscopy and real-time polymerase chain reaction (PCR) in a consecutive population of 324 asymptomatic refugees examined in Edmonton, Canada, during 2009-2010. Although all thick and thin blood smear results were negative, 10 subjects (3.1%) tested PCR positive for Plasmodium DNA. Interestingly, 6 of 10 PCR positive subjects are at risk of malaria relapse by P. vivax or P. ovale infections. These results suggest that appropriate guidelines for malaria screening should consider the risk of relapsing infections, and they highlight the potential usefulness of real-time PCR in the diagnosis of asymptomatic malaria.

Sleep characteristics in children with growth hormone deficiency

BACKGROUND/AIMS

Growth hormone (GH) is preferentially secreted during slow wave sleep and the interactions between human sleep and the somatotropic system are well documented, although only few studies have investigated the sleep EEG in children with GH deficiency (GHD). The aim of this study was to evaluate the sleep structure of children with dysregulation of the GH/insulin-like growth factor axis.

METHODS

Laboratory polysomnographic sleep recordings were obtained from 10 GHD children and 20 normal healthy age-matched children. The classical sleep parameters were evaluated together with sleep microstructure, by means of the cyclic alternating pattern (CAP), in GHD patients and compared to the control group.

RESULTS

GHD children showed a significant decrease in total sleep time, sleep efficiency, movement time and in non-rapid eye movement sleep stage 2. Although some indicators of sleep fragmentation were increased in GHD children, we found a general decrease in EEG arousability represented by a significant global decrease in the CAP rate, involving all CAP A phase subtypes.

CONCLUSIONS

The analysis of sleep microstructure by means of CAP, in children with GHD, showed a reduction of transient EEG amplitude oscillations. Further studies are needed in order to better clarify whether GH therapy is able to modify sleep microstructure in GHD children, and the relationships between sleep microstructure, hormonal secretion and neurocognitive function in these patients.

Allopregnanolone levels decrease after gonadotropin-releasing hormone analog stimulation test in girls with central precocious puberty

BACKGROUND

Allopregnanolone, a neuroactive steroid mainly secreted by adrenals and gonads, is a hormone that seems to play a role in precocious puberty, as demonstrated by its high baseline levels found in girls with central precocious puberty (CPP). Allopregnanolone concentrations significantly increase after GnRH and ACTH stimulation test suggesting both its ovarian and adrenal production.

AIM

Aim of this study was to evaluate allopregnanolone concentrations after GnRH and GnRH agonist analog stimulation test in girls with CPP to better establish its secretion source.

SUBJECTS AND METHODS

Gonadotropins and steroid hormones were evaluated in different days after GnRH and triptorelin stimulation test in 15 CPP girls.

RESULTS

After GnRH stimulation, LH, FSH, and allopregnanolone concentrations significantly increased (p<0.05). After triptorelin administration LH, FSH, estradiol and DHEAS levels significantly increased (p<0.05), while allopregnanolone concentrations significantly decreased (1.08±0.24 vs 0.87±0.28 nmol/l; p=0.003).

CONCLUSIONS

The different response of allopregnanolone to GnRH and GnRH agonist analog might reflect the agonist and antagonist action exerted by these secretagogues. Our data suggest the prevalent gonadal allopregnanolone production in CPP subjects and the usefulness of its measurement in the diagnosis of CPP.

Arachnoid cysts of the middle cranial fossa accompanied by subdural effusions--experience with 60 consecutive cases

BACKGROUND

Subdural effusions (SDEs) can complicate arachnoid cysts of the middle cranial fossa (ACMFs). While there is a consensus that at least in adults asymptomatic ACMFs should not be operated, those with concomitant subdural and/or intracystic effusions are clinically apparent in the majority of cases and should be surgically treated. But it remains unclear, which surgical procedure is best.

METHODS

Since 1980, 60 out of 343 patients with an ACMF presented with accompanying SDEs. Four categories of SDEs were differentiated radiologically. This collective was controlled in a follow-up study up to 60 months after conservative or operative treatment by clinical and radiological means.

RESULTS

In 54 of the 60 patients, we saw an indication for surgical treatment. Twenty-nine patients received a burr hole, 13 cases were treated by craniotomy, seven by endoscopical means, three patients underwent shunting and two combined procedures. Six patients were treated conservatively. An excellent final clinical outcome was observed in 55 cases. While craniotomy succeeded best to reduce the cyst volume in postoperative CT, the final clinical outcome did not differ significantly compared with burr hole trepanation.

CONCLUSIONS

Patients with small effusions can be treated conservatively in selected cases. Based on our experience, we prefer a differentiated therapy. As first procedure, burr hole and subdural drainage were performed, leaving the cyst alone, seeming sufficient for the majority of cases. Craniotomy or endoscopical means should be reserved as treatment of choice for special cases, depending on category and acuteness of SDE and size/localisation of the ACMF.