Head injuries in children resulting from the fall of television

Case records of children admitted with head injury due to TV fall in a pediatric tertiary care hospital in Chennai, during March 2007-February 2008 were analysed retrospectively. Out of the 11 children admitted 6 (54%) were in 1-2 yr age group. Bleeding from the ear, nose and throat was the commonest, finding followed by a skull fracture, seen on imaging studies. These were observed in 9 (81.81%) and 8 (72.8%) children respectively. There was no mortality.

Massive triventricular teratoma in an infant

A massive teratoma occupying both the lateral ventricles and the third ventricle in an infant is reported. The limitations of nomenclature are also indicated.

Aneurysmal bone cyst of the temporal bone

Aneurysmal bone cysts are uncommon lesions of the bone, which are benign and non-neoplastic in nature. They are commonly seen in the long bones. Their occurrence in the calvarium is rare. We report the occurrence of an aneurysmal bone cyst in the temporal bone of a young boy, which eroded the posterior part of the orbit to cause proptosis.

Giant orbital and intracranial xanthogranuloma--a short report

Xanthogranuloma are known to arise in the paranasal sinus or orbit. They may also arise primarily in the brain. Those arising from the sinuses or orbit might involve the intracranial cavity to some extent. But an extensive involvement of the cranial compartment is very rare. This report describes one such case.

Intramedullary abscess of the spinal cord

A case of intramedullary abscess of the spinal cord in a child aged 3 years is reported. Successful outcome depends on early diagnosis and aggressive management.

CSF ascites: a rare complication of ventriculoperitoneal shunt surgery

CSF ascites is a very rare complication of ventriculoperitoneal (VP) shunt procedure. No definite explanation has been offered for the inability of the peritoneum to absorb the CSF. Two children who underwent VP shunting for hydrocephalus, presented with ascites 3 (1/2) years and 4 months respectively, after the shunt was placed. The treatment of choice is conversion of the VP shunt to a ventriculoatrial shunt.

Medulloepithelioma of the optic nerve with intradural extension--report of two cases and a review of the literature

Medulloepithelioma is an uncommon tumour. Among the various sites of origin the optic nerve is rare. We report here two cases of medulloepithelioma of the optic nerve that had extended intradurally into the cranial cavity. A review of the published cases is also given.

Natural history of isolated ventricular septal defect in the first five years of life

BACKGROUND

Isolated ventricular septal defect (VSD) is the most common congenital heart defect. Incidence, prevalence, and clinical outcomes of VSD have been reported to vary significantly in different geographic areas. Spontaneous closure of VSD, in children, by various methods has been described.

HYPOTHESIS

This prospective study was undertaken to evaluate natural history of patients with VSD in the first five years of life in the Northeast Tennessee and Southwest Virginia region.

METHODS

Between December 1, 1998 and October 31, 1990, 124 infants were diagnosed clinically with isolated VSD. VSDs were classified as muscular, perimembranous, malalignment, or subpulmonic types by 2-dimensional echocardiogram with color flow mapping. Cardiac catheterization and angiocardiography were performed in 14 patients when clinically indicated. These patients were followed for at least five years.

RESULTS

Overall spontaneous closure of VSD was 34% at one year and 67% at five years. Twenty-five percent of perimembranous and 4% of muscular VSDs required surgery by five years. The spontaneous closure rate of muscular VSD was twice that of the perimembranous type, though the relative distribution of both types was almost equal. Overall, 22% of children with VSD need follow-up after the fifth year of life.

CONCLUSION

The overall clinical outcome of muscular VSD was consistently better than that of the perimembranous type, though 17% of muscular VSDs, irrespective of size, were open at 5 years of age and needed long-term follow-up.

Teratoid malignant medulloepithelioma of the optic nerve: report of a case and review of the literature

Medulloepithelioma of the optic nerve is extremely rare and can simulate an optic nerve glioma. We report a histopathologically proven medulloepithelioma in a 3-year-old child with computer tomographic (CT) and magnetic resonance imaging (MRI) features.

Identical twins with medulloblastoma occurring in infancy

Familial cerebellar medulloblastomas occurred in monozygotic twin siblings during infancy, and they had a rapid downhill course. Both twins underwent surgery for the tumours. This was followed by chemotherapy in the second twin. Both died after a short time. The tumours were seen to arise from the cerebellum and both had almost identical histomorphological features. To the best of our knowledge, this is the second report of familial medulloblastoma in twin siblings. Our observation suggests an underlying genetic influence in the histogenesis of these tumours.

Meningioma without dural attachment in a child

A case of posterior cranial fossa meningioma without dural attachment is presented. The patient was 8 years old. The tumour was mostly in the cerebellum and was presumably arising from the telechoroidea. Meningiomas without dural attachment are uncommon. They are rarer in the posterior fossa and in very young children.

Familial symptomatic sinus bradycardia: autosomal dominant inheritance

Symptomatic sinus bradycardia, due to either sick sinus syndrome or vagotonia, can be familial, affecting several members of a family. We report an 18-year-old male patient with palpitations and limited exercise capacity who was noted to have severe sinus bradycardia. His resting heart rate was 40/min, with normal PR and corrected QT intervals, and sinus pauses up to 6 seconds during sleep. Exercise treadmill test and pharmacologic autonomic blockade during electrophysiologic studies abolished the bradycardia, suggestive of vagotonia rather than intrinsic sinus node dysfunction. This patient's father and a female cousin had a similar clinical history but associated with syncope and severe sinus bradycardia. The mode of transmission appeared to be autosomal dominant. All three have permanent demand pacemakers implanted and are asymptomatic.

Radiologic abnormalities of the sternum in Turner's syndrome

Various skeletal abnormalities, including chest deformity, have been reported with Turner's syndrome. We report radiologic findings of the sternum on lateral chest roentgenograms in 15 children and adolescents with Turner's syndrome, whose ages ranged between 2 weeks and 20 years. Eight had associated congenital heart disease (CHD). Twelve patients (80 percent) had various sternal abnormalities; 5 had short sternum, 3 had premature fusion of the manubrio-sternal junction, and 4 had premature fusion of the mesosternum. Five had decreased ratio of sternal body to manubrium. Three patients had two ossification centers of the manubrium. Four patients had bowing of the mesosternum; three of these had mild pectus excavatum also. In this series, children with and without CHD had similar sternal abnormalities. Although not pathognomonic, sternal abnormalities on a lateral chest roentgenogram are common skeletal abnormalities associated with Turner's syndrome and are independent of associated CHD. In our series of 15 patients, 10 had monosomy (45,X) on blood karyotype; 7 of them had associated CHD. This is the first systematic analysis of radiologic abnormalities of the sternum in Turner's syndrome and includes findings not previously reported.

Pharmacokinetics of nadolol in children with supraventricular tachycardia

The pharmacokinetics of intravenous and oral nadolol, a long-acting beta-adrenoceptor blocking agent, were investigated in six children receiving the drug for treatment of supraventricular tachycardia. In the youngest patient (age 3 months), no distribution phase was seen. In children younger than 22 months of age, nadolol is more rapidly eliminated (t1/2 = 4.3 hours or less) than in older children, in whom elimination is more similar to that in adults (t1/2 approximately 7.3-15.7 hours). After intravenous administration, nadolol displayed two-compartment pharmacokinetics with a distribution phase (t1/2 = 0.2-1.1 hours) followed by elimination. Large changes in nadolol pharmacokinetics may occur during the first year of life. Nadolol should be used cautiously in infants.

Currarino-Silverman syndrome (pectus carinatum type 2 deformity) and mitral valve disease

Currarino-Silverman syndrome is a rare disorder characterized by premature fusion of manubrio-sternal joint and the sternal segments, resulting in a high carinate chest deformity; it is frequently associated with congenital heart disease. Among the various heart lesions reported in this syndrome, mitral valve disease and coarctation of the aorta have not yet been described (to our knowledge). Our report consists of five children with this syndrome, four of whom had mitral valve disease, with an associated coarctation of the aorta in one patient. The fifth patient had an innocent heart murmur.

Ventricular septal defect in the first year of life

Of approximately 22,000 live births in the region under study during the last 4 years, ventricular septal defect (VSD) was identified as the primary or isolated congenital heart lesion in 124 infants who were followed up from birth for a minimum of 1 year (incidence, 5.7 per 1,000 live births). Doppler color flow mapping was performed in 93 of 124 patients; 47 had a muscular VSD and 46 had a perimembranous VSD. Only 1 patient had 2 muscular VSDs. None had a subpulmonic type of defect. Of 124 patients, 14 were lost to follow-up. Spontaneous closure was seen in 18 patients (42%) in the muscular group, in 9 (23%) in the perimembranous group and in 10 patients (37%) in the unclassified group by the end of the first year. The overall rate of spontaneous closure was 34% by the end of the first year. Congestive heart failure developed in 2 of 46 patients with muscular VSD and in 12 of 47 patients with perimembranous VSD. In the first year, 2 patients with muscular VSD as opposed to 5 with perimembranous VSD required surgery. Doppler color flow mapping is a valuable aid in the diagnosis of VSD and may be one reason for the observed increase in the incidence of VSD. The overall prognosis appeared much better in the muscular than the perimembranous type of VSD.

Efficacy and safety of intravenous and oral nadolol for supraventricular tachycardia in children

The efficacy and safety of oral nadolol in supraventricular tachycardia were evaluated prospectively in 27 children (median age 5.5 years). Fifteen patients had an unsuccessful trial of digoxin therapy. Intravenous nadolol was given to seven patients during electrophysiologic study; five of these had an excellent response and two had a partial response (25% decrease in tachycardia rate). Six of these patients had a similar response to oral nadolol. Twelve patients received both propranolol and nadolol. Among six patients, intravenous propranolol was successful in four and unsuccessful in two; all six had a similar response to oral nadolol. With oral propranolol, tachycardia was well controlled in four patients and persistent in two; five of five patients had a similar response to oral nadolol. Twenty-six patients were treated with oral nadolol; the arrhythmia was well controlled in 23, 2 had recurrent tachycardia and 1 patient had tachycardia at a 25% slower rate. The effective dose of nadolol ranged between 0.5 and 2.5 mg/kg body weight once daily (median dose 1 mg/kg per day). During follow-up (3 to 36 months), compliance and tolerance were excellent; excluding 2 patients with reactive airway disease who developed wheezing, only 3 (12%) of 24 had side effects necessitating a change in drug therapy. Once a day nadolol is a safe and effective agent in the management of supraventricular tachycardia in children. Its long-term efficacy can be predicted by the short-term response to intravenous nadolol or propranolol during programmed electrophysiologic study.