[Fibro-osseous pseudotumor of the hand in a 5-year old boy - a close relative to myositis ossificans]. / Fibroossärer Pseudotumor in der Hohlhand eines 5-jährigen Jungen - ein naher Verwandter der Myositis ossificans.

Fibro-osseous pseudotumors of the hand are rare lesions in children. Clinical and radiological presentation can be challenging and simulating a malignant neoplasm. We present the case of a 5-year-old boy with a rapidly growing soft tissue tumor of the right palm. Diagnosis was confirmed by biopsy and the patient was treated with a tissue preserving resection. There was no evidence for recurrence 1 year after the operation.

[Congenital nasal pyriform aperture stenosis: an uncommon, potentially fatal cause of inhibition of nasal breathing in neonates]. / Kongenitale Stenose der Apertura piriformis: Seltene, potenziell lebensbedrohliche Ursache einer Nasenatmungsbehinderung bei Neugeborenen.

Congenital nasal pyriform stenosis can be a life threatening emergency in neonates which must be included in the differential diagnosis of nasal airway obstruction. We describe the case of a male child who developed symptoms 36 h after birth. As the conservative therapy was not successful surgery became necessary.

Minimally invasive repair of pectus excavatum--the Nuss procedure. A European multicentre experience.

Since the first description in 1998, the minimally invasive repair of pectus excavatum has gained increasing acceptance. The aim of this survey is to report on the experiences of eight European centres with this technique. 172 patients with a mean age of 15.1 (+/- 4.6) years were treated and evaluated, 35.5 % were symptomatic. 45.3 % of the patients had an asymmetric configuration of the chest, 74.3 % had a CT index above 3.25. Mean duration of the operative procedure was 76 minutes. Major complications, including dislocation of the bar or stabiliser, pneumonia, atelectasis, local infection, pleural and pericardial effusion and liver injury occurred in 11.1 % of the patients. Minor complications, such as self-resolving pneumothorax, atelectasis and subcutaneous emphysema were reported in another 8.1 %. Early cosmetic results were excellent or good in 81.5 %. Although the surgical procedure is simple, blood-sparing and short, consideration of some important technical details, proper patient selection and knowledge of the limitations is of vital importance. Long-term results are still lacking.

[Computer-supported patient history: a workplace analysis]. / Die computerunterstützte Krankengeschichte: eine Arbeitsplatzanalyse.

Since 1991, an extensive computer network has been developed and implemented at the Cantonal Hospital of Lucerne. The medical applications include computer aided management of patient charts, medical correspondence, and compilation of diagnosis statistics according to the ICD-9 code. In 1992, the system was introduced as a pilot project in the departments of pediatrics and pediatric surgery of the Lucerne Children's Hospital. This new system has been prospectively evaluated using a workplace analysis. The time taken to complete patient charts and surgical reports was recorded for 14 days before and after the introduction of the computerized system. This analysis was performed for both physicians and secretarial staff. The time delay between the discharge of the patient and the mailing of the discharge letter to the family doctor was also recorded. By conventional means, the average time for the physician to generate a patient chart (26 minutes, n = 119) was slightly lower than the time needed with the computer system (28 minutes, n = 177). However, for a discharge letter, the time needed by the physician was reduced by one third with the computer system and by more than one half for the secretarial staff (32 and 66 minutes conventionally; 22 and 24 minutes respectively with the computer system; p < 0.0001). The time required for the generation of surgical reports was reduced from 17 to 13 minutes per patient and the processing time by secretaries from 37 to 14 minutes. The time delay between the discharge of the patient and the mailing of the discharge letter was reduced by 50% from 7.6 to 3.9 days.(ABSTRACT TRUNCATED AT 250 WORDS)

[Para-articular hip fracture in childhood]. / Hüftnahe Frakturen im Kindesalter.

Femoral neck fractures during childhood are very rare. Up to 60% complications have to be expected due to the special epiphyseal development and vascularization, i.e. necroses of the femoral head, pseudarthroses and growth disturbances. Only undislocated fractures are treated conservatively in a plaster cast. The end result may be improved with early reposition and operative treatment. The outlook of our own 16 cases using this procedure was considerably better than in the current literature. The preferred technique consists of stabilizing the fracture with a cannulated screw and two K-wires to prevent rotation. For pertrochanteric, mostly pathologic fractures, a T-plate in conjunction with cannulated screws and transplantation of homologous spongiosa has proved successful.

Hematogenous calcaneal osteomyelitis in children.

Heel pain is a frequent complaint in children due to intensive school and leisure-time sports. Heel pain accompanied by inflammatory signs has to be considered as osteomyelitis until the opposite is proven. From 1980 to 1989, twenty children were treated for acute or subacute osteomyelitis of the calcaneus (OMC) at the Department of Pediatric Surgery of the Children's Hospital of Lucerne. The schema of investigation comprising laboratory work-up, x-rays, scintiscanning and aspiration of the focus makes quick and accurate diagnosis possible. Exogenous osteitis of the newborn and calcaneal apophysitis in children must be differentiated; this is a prime consideration. Treatment includes surgical interventions (curettage, drainage) and long-term antibiotics. The course of the disease can be shortened, complications become avoidable and the rate of recurrence is diminished.

[Shaft fractures in infancy]. / Schaftfrakturen des Kleinkindesalters.

Shaft fractures in young children have certain characteristics that are related to the type of accident and bony structure of this age group, the rapid healing process, and the long subsequent growth period. 1. Due to the high incidence of falls, green-stick, compression, and torsion fractures predominate. 2. Reduction and immobilization can nearly always be achieved by conservative treatment or simple osteosynthetic procedures. 3. The intensive remodelling process makes precise reduction unnecessary. Tolerance is greatest for side-to-side displacement and least for rotational deformities, especially in the forearm and leg. 4. The most common consequence of fracture healing is overgrowth of the fractured extremity, the intensity of which increases in proportion to the degree of spacing in the fracture area. 5. Complications are uncommon and are due mainly to overlooked rotational deformities, repeated manipulations, erroneous indications, or inappropriate internal fixation. 6. Anticipation of further growth is never an acceptable excuse for leaving an improperly aligned fracture to be "outgrown". 7. When certain basic precepts peculiar to this age group are observed, the treatment of shaft fractures in young children nevertheless carries a favorable prognosis.