The influence of locally implanted high doses of gentamicin on hearing and renal function of newborns treated for acute hematogenous osteomyelitis.

BACKGROUND: [corrected] Osteomyelitis and arthritis still present a serious diagnostic and therapeutic problem. Difficulties arise in particular in the treatment of acute hematogenic osteomyelitis (AHO) in newborns where mega-doses of gentamicin are administered locally for about 3 weeks. Gentamicin possesses strong oto- and nephrotoxicity and the occurrence of these adverse effects depends on the duration of treatment and the serum drug concentration. OBJECTIVE: Aim of the study was to evaluate the influence of local gentamicin application on auditory and kidney functions. MATERIAL AND METHODS: Twenty newborns (14 boys and 6 girls) with AHO were treated at the Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland, by local implantation of miniseptopal or gentamicin sponge. Serum urea, creatinine, antibiotic concentrations and NAG activity/g creatinine ratio in urine were estimated before and 1, 4, 8, 16 days after the operation and compared to values in the control group. Brainstem-evoked auditory potentials (BAEP) were examined before, during the first 3 weeks, and 6-11 months after gentamicin implantation. RESULTS: Mean gentamicin serum concentrations were: 0.67 +/- 0.98 mg/l on the 1st day, 0.16 +/- 0.37 mg/l on the 4th day, 0.03 +/- 0.09 mg/l on the 8th day, 0.01 +/- 0.03 mg/l on the 16th day after operation and did not exceed the upper limit of the therapeutic range. N-acetyl-beta-D-glucosaminidase (NAG)/g creatinine in urine ratios were satisfactory: 77.91 +/- 36.22 UI/g before the operation, 146.51 +/- 82.27 UI/g on the 4th, 162 +/- 111 UI/g on the 8th, 168 +/- 59.83 UI/g on the 16th day after operation and were statistically significantly (p < 0.05) higher than values in the control group. Serum urea and creatinine levels were in the normal range in all groups. Initial BAEP were well in the normal range in 15 of 16 children before treatment and in 14 of 16 children after treatment. CONCLUSIONS: Locally applied gentamicin as miniseptopal or sponge in newborns produces gentamicin concentrations close to the minimal therapeutic serum concentration which are present over a prolonged period. The raised NAG values in urine and normal serum urea and creatinine levels during treatment with gentamicin without concomitant clinical symptoms of renal failure suggest subclinical destruction of the renal tubules. Lack of change in BAEPs shows that there is no impairment of auditory function.

Midfacial fractures in children.

The purpose of the study was to present a modern classification and discuss the treatment of midfacial fractures in children. From the beginning of 1 January 1998 to 31 October 2000, 147 children were treated for different craniofacial fractures. Among them 28 patients (19 %) had extensive midfacial fractures complicated by impaired vision and/or CNS dysfunction and were treated surgically. The fractures were divided into: zygomatico-orbital (1 pt) and zygomatico-orbito-maxillary (5 pts), isolated orbital wall fractures (14 pts) and naso-orbital dislocations (2 pts), upper facial portion dislocations (2 pts) and fronto-naso-orbital (2 pts) or cranio-orbital fractures (2 pts). Clinical examination revealed mainly dysfunction of facial morphology and aesthetics (enophthalmos, telecanthus), CSF leakage, impairment of vision and restricted eyeball movements. Ophthalmological, neurological and radiological (Waters view, CT, NMR) examinations were performed in all cases. The treatment consisted of bone repositioning, reconstruction with autologous bone grafts and three-dimensional stabilisation using titanium plates. Twenty-three pts were operated on before and 5 pts after 7th day after trauma. The restoration of normal facial morphology was achieved in 26 patients. In 2 cases it was impossible because of the destruction of soft tissue and an extremely extensive bony trauma. Better reposition of bony fragments, prompt healing and better final results were achieved in patients operated before day 7 after trauma. Achieving good results in midfacial fractures requires prompt and adequate treatment and a multidisciplinary (paediatric, maxillofacial, plastic surgeons, neurosurgeon, ophthalmologist) team.

[The influence of orthosilicon acid on traumatic edema of the skin. Introduction]. / Wplyu kwasu ortokrzemowego na obrzeki pourazowe skóry. Doniesienie wstepne.

In the Ward of Children Surgery of the local Hospital 35 children from 0 to 15 years old with burn wounds of skin of different degrees have been treated. In surface, medium-deep and deep wounds regression of oedema, reddening and inflammatory reaction were observed already from 2nd day of treatment. Suppuration of wounds was not observed. It was observed that orthosilicon acid has anti-edematous and cooling (reduces pain) effect, quickens epidermization and shortens the time of appearing of granulation in deep burns. We think that orthosilicon acid is preparation worth further clinical testing of its usage in skin illnesses.

[The surgical treatment of advanced stages of solid tumors in children]. / Leczenie chirurgiczne w zaawansowanych stadiach guzów litych u dzieci.

Hope for cure in children with advanced cancer came with introduction of chemo- and radiotherapy, however surgery is still important as a part of the multidirectional treatment. The aim of the review was to assess the impact of surgical treatment in children with advanced cancer. From 1991 to 1997, 30 patients aged from 6 months to 17 years were treated for soft tissue sarcomas (STS: stage III/8 pts, stage IV/2 pts), nephroblastoma (WT: stage IV/5 pts, stage V/3 pts), PNET/Ewing sarcoma (locally advanced/4 pts, metastatic/2 pts) and others (stage III/4 pts, stage IV/2 pts). All patients received pre- and postoperative chemotherapy, all but 6 were irradiated. Twenty one of 30 patients entered remission (CR) after radical surgery for local control: 12 relapsed locally, of whom 7 entered IICR after re-treatment and next surgery and 5 died. 3 of 9 patients who never had any local relapse, died of metastases. Nine of 30 patients never had any radical surgery, 8 died (including 2 toxic deaths) and 1 (stage V Wilms tumour) is in CR after chemotherapy and radiotherapy (12 Gy including both kidney with unresectable tumours). Advanced cancer does not imply the fatal outcome: 14/30 patients are in CR. Possibility of surgical resection of the disease focuses brings some hope for final cure even in initially disseminated disease: 13 such cases of 21 are in ICR or IICR (follow-up: 6 months-7 years) whereas only 1 of 9 those who have never had any radical surgery.

[Alternative methods of central venous access insertion in pediatric oncology]. / Alternatywne sposoby wprowadzania centralnego dostepu zylnego w onkologii dzieciecej.

UNLABELLED: Introduction of the central venous access (CVA) in children treated for malignancies is usually planned procedure. Some patients however require the CVA in emergency. Also in emergency, insertion of CVA should be feasible and safe. The standard technique of CVA insertion is through surgically approached internal jugular vein. This technique requires correct blood coagulation and general anaesthesia in younger patients. Alternative ways of the CVA insertion (via cephalic vein, cubital vein or external jugular vein) seem safe also in case of thrombocytopenia (< 40,000/mm3) and coagulopathy. Aim of the report is to compare efficacy (central tip of the catheter in the superior vena cava on X-ray) and safety (complication rate) of both techniques. PATIENTS: 166 children treated for malignancies aged from 0 to 16 years. The standard technique was used in 109 and in 107 was successful. The alternative technique was used in 57 and in 50 was successful. There were no acute complications, the late ones were observed in 7 of 107 in the standard technique group and in 9 of 50 in the alternative technique group. The alternative ways of the CVA introduction are effective and safe, however the longer X-ray monitoring is necessary.

Helicobacter pylori infection in Eastern Europe: seroprevalence in the Polish population of Lower Silesia.

The Helicobacter pylori status of the population of Eastern European countries has not been explored despite the high incidence of peptic ulcer disease and gastric cancer observed in these countries. A seroprevalence study has been performed in Wroclaw, a city of Lower Silesia, Poland, to provide insight into this question. Sera were collected to obtain 50 subjects per 5 yr increment of age. A second generation ELISA kit with a high sensitivity and specificity was used. The results plotted by year of birth show a very high prevalence of H. pylori infection in all adults groups born before 1970 (80-100% positive). In the younger age groups, a dramatic decrease was observed. Because it is now known that most H. pylori infections are acquired in childhood (cohort effect), it can be predicted that the infection rate in the adult population will be much lower in the future compared with that presently observed, and it can be expected that evolution in H. pylori prevalence will have an impact on the rate of gastroduodenal diseases in Poland. Because of the high prevalence, it was not possible to identify risk factors for infection in this population.