Nonaccidental traumatic dislocation of the hip in a 3-year-old child: a report of a rare pediatric injury

Traumatic hip dislocations are rare in children, and reports of these injuries focus primarily on the risk of osteonecrosis of the femoral head as well as the long-term efficacy of treatment. Anatomical characteristics of the hip in young children, such as ligamentous laxity and a pliable acetabulum, can allow hip dislocation with low-energy trauma, but these injuries occur primarily in school-aged children during play activities. We report a hip dislocation in a 3-year-old child with no clear explanation of the mechanism of injury and with multiple unexplained bruises at different stages of healing that led to the diagnosis of nonaccidental trauma (NAT). This case highlights the need to consider NAT in young patients with a traumatic hip dislocation.

Homeopathic treatment for chronic disease: a 6-year, university-hospital outpatient observational study

OBJECTIVE

The aim of this study was to assess health changes seen in routine homeopathic care for patients with a wide range of chronic conditions who were referred to a hospital outpatient department.

DESIGN

This was an observational study of 6544 consecutive follow-up patients during a 6-year period.

SETTING

Hospital outpatient unit within an acute National Health Service (NHS) Teaching Trust in the United Kingdom.

PARTICIPANTS

Every patient attending the hospital outpatient unit for a follow-up appointment over the study period was included, commencing with their first follow-up attendance.

MAIN OUTCOME MEASURE

Outcomes were based on scores on a 7-point Likert-type scale at the end of the consultation and were assessed as overall outcomes compared to the initial baseline assessments.

RESULTS

A total of 6544 consecutive follow-up patients were given outcome scores. Of the patients 70.7% (n = 4627) reported positive health changes, with 50.7% (n = 3318) recording their improvement as better (+2) or much better (+3).

CONCLUSIONS

Homeopathic intervention offered positive health changes to a substantial proportion of a large cohort of patients with a wide range of chronic diseases. Additional observational research, including studies using different designs, is necessary for further research development in homeopathy.

Does measurement of yield pressure at the cardia during endoscopy provide information on the function of the lower oesophageal sphincter mechanism?

We describe a technique for measuring the yield pressure at the cardia during upper gastrointestinal endoscopy. The test was applied to 47 patients with macroscopic oesophagitis and nine patients with achalasia. Controls were 123 patients from the routine endoscopy list in whom no abnormality was found and 21 healthy volunteers. Yield pressure was similar in both control groups, but was significantly higher in achalasia (p less than 0.001) and lower in oesophagitis (p less than 0.001). Yield pressures fell dramatically after pneumatic dilatation in the achalasia patients. The test was reproducible and yield pressure was not affected by age, sex, weight, or sedation. Measurement of yield pressure during endoscopy provides information which may reflect the function of the whole antireflux mechanism, and not just the lower oesophageal sphincter.