[Pneumococcal meningitis in children]. / Pneumokoková meningitida u detí.

OBJECTIVE: Presented are the authors' own experiences with invasive pneumococcal diseases in a group of pediatric inpatients with pneumococcal meningitis treated in the Department of Infectious Diseases, University Hospital and Charles University Faculty of Medicine in Hradec Králové over the last 10 years. MATERIAL AND METHODS: A group of patients aged 0-18 years and hospitalized in the above facility in 2002-2011 was retrospectively assessed. The patients' basic clinical characteristics and treatment outcomes are shown below. RESULTS: Over the study period, 27 children with pneumococcal meningitis were treated; of those, 15 were boys and 12 were girls. The patients' ages ranged from 2 days to 17 years; seventeen children (63 %) were younger than 2 years. On admission, 11 children (40 %) had the infection in the middle ear or paranasal sinuses; intracranial complications were noted in 10 cases. Cerebrospinal fluid culture was positive for Streptococcus pneumoniae in 21 cases. In 6 patients, pneumococcal DNA was determined in the cerebrospinal fluid by PCR. None of the studied patients died. Eight children (29 %) were left with permanent damage; of those, seven had hearing impairment. CONCLUSION: Even today, pneumococcal meningitis in children remains a serious condition posing a risk of dangerous consequence or even death. To the maximum extent possible, prevention should include vaccination, especially in infants and children with the predisposing factors.

[Retrogastric bronchogenic cyst]. / Retrogastrická bronchogenní cysta.

The authors present a case of an incidental finding of an asymptomatic retrogastricaly localized bronchogenic cyst. In a 3.5 year old boy, abdominal US, which was performed because of constipation complains, revealed a cystic mass. MRI study confirmed the presence of a simple cyst, located in the retrogastric region. The patient underwent laparotomy and the cyst, measuring 3 cm in a diameter, was removed from the omental bursa. During the postoperative period, no complications or symptoms were recorded. Histologicaly, the finding was surprisingly identified as a bronchogenic cyst. Occurence of bronchogenic cysts within the abdominal cavity is reported very rarely in the literature.

Urinary N-acetyl-beta-D-glucosaminidase (U-NAG) activity in children with vesicoureteral reflux.

OBJECTIVES: The aim of this study was to measure U-NAG in children with vesicoureteral reflux (VUR) and examine the relationship between selected clinical parameters. BACKGROUND: U-NAG/creatinine ratio is a marker of renal tubular impairment and an increase in this ratio have been reported to affect the kidneys in various diseases. METHODS: The U-NAG/creatinine ratio was measured in the spot urine of 22 children (10 boys and 12 girls, mean age 2.83 +/- 2.42 years) with VUR. In 8 patients The VUR was unilateral grade I-IV (8 patients), and it was was bilateral, grade I-V in 14 patients. In patients with bilateral reflux and different VUR grade on each side, the highest grade of VUR was taken into consideration. RESULTS: The U-NAG/Cr levels were significantly higher in VUR patients compared to the reference (p = 0.0001). There was no difference in U-NAG/Cr between children with unilateral (n = 8) and bilateral (n = 14) VUR (p = 0.66). There was no difference in U-NAG/Cr between patients with VUR grades I-III and IV-V (p = 0.67). The U-NAG/Cr activity was higher in patients with reflux nephropathy (RN; n = 9) when compared to reference data (p = 0.0001), however there was no difference in comparison to children without RN (p = 0.84). CONCLUSIONS: U-NAG/Cr increased in children with VUR grade I-V and there is a very weak relationship with the grade of VUR. U-NAG/Cr is a useful marker of renal tubular impairment, however there is poor relationship with the degree of kidney damage in patients with VUR (Tab. 1, Ref. 25). Full Text (Free, PDF) www.bmj.sk.

[Significance of the radial artery pulse in dislocated supracondylar fractures of the humerus in children]. / Význam pulzace arteria radialis u dislokované suprakondylické zlomeniny humeru u detí.

The importance of palpable or non-palpable pulsation of the radial artery in children with supracondylar fractures of the humerus is still not correctly appreciated either in the practice or in the literature. Despite the relatively frequent occurrence both the diagnostic and therapeutic procedures are not yet uniform. The objective of this study was to evaluate retrospectively the importance of the pulsation of the radial artery in children with this injury treated in author's departments. Impaired pulsation was recorded in 24 of 244 children (9.8%). In all of 7 patients with impaired pulsation in the years 1984-1992 a vascular operation was made. On the other hand, during the period from 1993 till June 30, 1999, only 4 patients were thus operated on for this reason. In other 7 children pulsation was restored immediately after reposition and percutaneous pinning, while in the remaining 6 children with obstruction of the brachial artery confirmed by triplex Doppler examination pulsation was restored within 1-18 days, always without complications and sequelae. Based on their own results and data in the literature, the authors draw attention to the relative independence of the feared Volkmann's contracture on palpable or non-palpable pulsation of the radial artery and to the minor importance of urgent vascular reconstruction if the collateral circulation is satisfactory. In the case of patent circulation in the hand and forearm muscles a minimal invasive (closed) approach to treatment is possible in spite of concurrent obliteration of the brachial artery, just with reduction and percutaneous pinning of the displaced fracture with K-wires.

[Diverticulosis of the small intestine--case report]. / Divertikulóza tenkého streva--kazuistika.

The authors describe the case of a 86-year-old female patient admitted to hospital with acute abdomen of the inflammatory type. The condition developed in the course of cca three days with sudden deterioration on the day of admission to hospital. Contrast X-ray examination revealed perforation of the distended jejunum and surgery revealed diffuse peritonitis the source of which was the mentioned perforation associated with mechanical ileus caused by malrotation and adhesions of the small intestine. An additional finding which, however, dominated on X-ray examination of the gastrointestinal tract when using contrast material and on revision of the peritoneal cavity was multiple diverticulosis of the small intestine. The uncommon finding on the small intestine and the relatively sparse data in the literature on diverticulosis of the jejunum and ileum made us submit the case-history for publication.

Safety profile of paediatric percutaneous ultrasonography-guided renal biopsies.

INTRODUCTION: Renal biopsy (RB) is a decisive diagnostic procedure for patients with renal disease. Our aim was to assess the safety of RB and the prevalence of associated clinical complications. METHODS: A total of 166 RBs were performed in 164 children (88 boys, 76 girls) in East Bohemia in 1997-2007. The mean age of the children was 12.9 +/- 4.1 years. All RBs were performed by a single consultant nephrologist. 27 biopsies were performed in 27 patients (16.3 percent) in 1997 under radiography control, while the remaining 139 biopsies (83.7 percent) were performed under ultrasonographic guidance. Renal ultrasonography (USG) following RB was not a general rule in patients who were biopsied under radiography control before 1998; therefore, only the USG results in patients after USG-guided RB (n = 139) were evaluated. RESULTS: No major complications were encountered, and only minor complications occurred in 39 (23.5 percent) patients, which did not require medical intervention. The most common complication was asymptomatic perirenal haematoma, which was detected by USG one to three days after a USG-guided RB (30 out of 139 biopsies; 21.6 percent). Perirenal haematoma accompanied by abdominal pain occurred in two (1.4 percent) patients. Macroscopic haematuria was present in seven (4.2 percent) patients on Days 1-3 post biopsy. The complications were neither age-dependent nor were they related to the serum creatinine levels. CONCLUSION: The results obtained are consistent with those in other reports of paediatric patients. The absence of major complications is a favourable outcome. Thus, the present practice of USG-guided percutaneous RB in children is safe and clinically beneficial.