Cervical Spine Injury in Children and Adolescents.

Complaints related to the neck are common following mild pediatric trauma. Although significant cervical spine injuries are most often seen and evaluated in the emergency room or inpatient setting, the primary care provider is faced with the evaluation of lower acuity complaints. We provide a review to assist with the efficient evaluation of these patients to facilitate decisions regarding return to play, the need for imaging, and need for referral to subspecialty providers.

Serum amylase and lipase elevation is associated with intracranial events.

Serum amylase and lipase elevation has been observed in trauma patients and patients with traumatic intracranial bleeding. However, the causes of this elevation have not been clearly elucidated. A further question remains as to whether other intracranial events are associated with such enzyme elevation as well. We retrospectively reviewed 75 patients consecutively admitted to Cook County Hospital Neurosurgical Intensive Care Unit over a 3-month period for trauma, infection, tumor, or other space-occupying lesions with an unstable condition or neurological deficit. Eleven patients (15%) had elevated amylase and lipase levels. The patients were divided into two groups: Group I (n = 64) had normal and Group II (n = 11) had raised amylase and lipase levels [amylase 402 +/- 444 U/L with normal < or = 125 U/L and lipase 474 +/- 313 U/L with normal < or = 55 U/L]. All Group II patients suffered an intracranial event. Twenty-four Group I (38%) and 10 Group II (91%) patients required craniotomy (P < 0.01). No patients had clinical or radiographic evidence of pancreatitis. In summary, intracranial events are associated with serum amylase and lipase elevation probably through centrally activated pathways. Because of the lack of diagnostic value, routine pancreatic enzyme monitoring should not be performed in this patient population.

Vitamin D concentrations in women of postmenopausal age with fractures of the femoral neck.

Thirty-eight women of postmenopausal age, suffering from fractures of the femoral neck or vertebral bodies were studied in relation to differences in bone metabolism. The blood and urinary changes concerned in mineral and bone metabolism were recorded within 10 days of trauma, and in some femoral neck fractures, a histological study of the femoral heads removed in the course of prosthetic substitution was carried out. The patients with femoral neck fractures were older than those with vertebral fractures and had metabolic and histological findings suggestive of osteomalacia. A particularly significant difference between the two groups was the plasma level of 25 hydroxycholecalciferol, which was lower in femoral neck fractures, and the urinary excretion of calcium, which was also more reduced in femoral neck fractures. A deficit of vitamin D hepatic metabolite thus appears to be a risk factor for femoral neck fractures in old patients.

Urinary lactic dehydrogenase isoenzyme analysis in children with spinal lesions.

In 48 children with spinal lesions and micturition problems urinary lactic dehydrogenase (LDH) isoenzymes were analyzed. They had higher total LDH activities (716.8 +/- 1,050.2 nkat/I), isoenzymes V percents (22.2 +/- 13.0%) and isoenzyme V activities (203.4 +/- 308.4 nkat/I) than those of healthy children (150.0 +/- 83.4 nkat/I, 1.9 +/- 1.0%, 5.0 +/- 3.3 nkat/I). Many subjects had an isoenzyme V-dominant LDH isoenzyme pattern. Among 48 subjects the patients with pyuria, bacteriuria or abnormal pyelograms had markedly high total LDH activities, isoenzyme V percents and isoenzyme V activities. The rise in LDH isoenzyme V levels may reflect the renal damage in the patients with neurogenic bladders.