Chance fracture--a rare injury in pediatric patients?

We report on a 9-year-old girl who was involved in a car accident. She suffered severe polytrauma with torn abdominal muscles, rupture of the mesenteric arteries, bowel and bladder, hematoma at the right colonic flexure and disruption of the intervertebral ligaments L2/L3, including the intervertebral disc, typical of Chance fracture. The abdominal bleeding was stopped, the bowel resected and the fracture fixed by internal fixation. The patient developed a postoperative enterocutaneous fistula in the right flank and paraplegia. She underwent three laparotomies with ileostomy and closure of the fistula. Two years later, she has normal bowel movement, the wounds are closed, the internal fixation has been removed, she is able to walk with crutches and suffers from a mild bladder dysfunction. Chance fracture is a typical fracture in adults involved in motor vehicle accidents. In the last 10 years, there have only been four case reports describing this fracture in children under the age of 10. All of these individuals were involved in a car accident and had been fixed with a lap belt. With the increasing use of lap belts, this fracture has to be considered even in young children. Mild clinical symptoms can be associated with severe intra-abdominal injuries.

Extraction of di-ethylhexyl-phthalate from perfusion lines of various material, length and brand by lipid emulsions.

BACKGROUND: The plasticizer di-ethylhexyl-phthalate (DEHP) is extracted especially by lipid emulsions from polyvinylchloride infusion systems. The aim of this study was to systematically examine the extraction from perfusion lines commonly used in our hospital for lipid emulsion infusions. METHODS: Perfusion lines made from polyvinylchloride of various lengths and brands, polyethylene, polyvinylchloride/polyethylene (PVC/PE) and polyvinylchloride/polyurethane (PVC/PU), were perfused with lipid emulsions according to the circumstances of newborns on an intensive care unit, i.e. high temperature, 24-hour duration and low quantities. Concentration of di-ethylhexyl-phthalate was determined with gas chromatograph mass spectrometry. RESULTS: The lipid emulsions before perfusion had a contamination with DEHP of 0.82 microg/ml. Pure PVC lines of 1.5 m length leached between 74 microg/ml and 107 microg/ml. Sterilization of the lines did not influence DEHP extraction. After perfusion of DEHP-free PVC lines and PVC-free lines, the emulsions had a contamination with DEHP of 0.23 microg/ml and 0.11 microg/ml, respectively. PVC/PU co-extruded lines leached 73 microg/ml. PVC/PE lines leached 41.6 microg/ml. CONCLUSIONS: Lipid emulsions contain a production-inherent load of DEHP. Perfusion through PVC-perfusion lines extracts a varying large amount of DEHP depending on length and brand of the perfusion lines. Co-extruded PVC/PU and PVC/PE lines, intended to avoid DEHP contamination, leach a similar amount of DEHP and thus do not avoid the DEHP toxicity issue. The load accumulated by a baby on an intensive care unit easily reaches several milligrams of DEHP per day. As its effect upon biologic systems has been proven, and alternatives (PE or PU perfusion lines) are available, PVC and PVC co-extruded perfusion lines should be abandoned for infusions, especially in babies.

[Treatment of lymphangiomas with picibanil in the first year of life]. / Behandlung von Lymphangiomen mit Picibanil im ersten Lebensjahr.

BACKGROUND: The therapeutic gold standard of cystic hygroma is its complete resection. Because of its growth pattern and its main location in the head and neck region complete resection is not always possible. An alternative is the local injection of Picibanil, but only few cases have been published about its use in infants. PATIENTS/METHOD: We retrospectively analyzed the data of 8 infants (age: 2 weeks-12 months) who got Picibanil therapy because of cystic hygroma in the time period 2002 until 2006. Follow up ranged from 3 months up to 3 years. RESULTS: During the postoperative period all patients had local swelling, in 4 cases accompanied with local inflammation and fever. Tumor reduction of >50% was obtained in 7 of 8 patients. CONCLUSIONS: Local injection of Picibanil in infants with cystic hygroma seems to be a safe alternative to surgical therapy, especially when complete tumor resection means damage of important neighbouring structures. Prospective trials are necessary to confirm the better outcome after therapy with Picibanil compare to primary surgery.