Surgical treatment of active or aggressive aneurysmal bone cysts in children.

The aim of this study was to evaluate functional and radiological results, tumor control, and complications of the surgical treatment of aneurysmal bone cysts (ABCs) in children by extended curettage using a mechanical burr and cauterization, grafting, and internal fixation in specific locations. Sixty-four children [38 males, 26 females, median age=10 years (range, 5-18 years)] with active or aggressive ABCs of long and flat bones were subjected to a median follow-up of 66 months (range, 28-130 months) following surgical treatment. The pathological fracture rate was 72%. Surgical procedures included intralesional extended curettage (92%) or en-bloc resection (8%). Internal fixation was required in 53%. The pathological fractures healed successfully in 8-12 weeks. The median Musculoskeletal Tumor Society (MSTS) score at the last follow-up was 95% (range, 55-100%). Treatment failure (partial healing/recurrence) and complication rates following extended curettage were 7 and 5.2%, respectively. Statistically, the only parameter affecting partial healing and local recurrence was proximity of the lesion to the growth plate (P=0.011). Extended curettage using a mechanical burr and cauterization, grafting, and internal fixation in specific locations can promote healing in most cases of ABC, with low recurrence and complication rates.

Nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae in healthy children.

Streptococcus pneumoniae carriage is a risk factor for the development of respiratory system infections and the spread of penicillin-resistant strains. The aim of this study was to investigate nasopharyngeal carriage of S. pneumoniae in healthy children and resistance to penicillin and other antimicrobials and to assess related risk factors. Nasopharyngeal specimens collected from healthy children less than six years of age, visiting a Mother and Child Health Center for health control, were investigated microbiologically between February-March 2004. Carriage rate was 37.2% (n=112/301); 33.9% intermediate and 5.4% high penicillin resistance were detected. According to multivariate analysis, carriage rate was inversely related to number of rooms (OR:0.574) and child age (OR:0.978), while penicillin resistance was correlated well with antibiotic use in the last two months (OR:2.193). Decreased sensitivity plus resistance to other antimicrobials were: trimethoprim-sulfamethoxazole (TMP-SMX) 45.6%; erythromycin 16.1%, tetracycline 16.1%; clindamycin 9.8%, and ofloxacin 3.6% in pneumococcal isolates, which increased significantly (p<0.05) to 72.7%, 31.8%, 27.3%, 20.5%, and 6.8%, respectively, in penicillin non-sensitive S. pneumoniae (PNSSP) except for ofloxacin. Overall multidrug resistance was 17.9%, while PNSSP exhibited a resistance rate of 38.6%. In conclusion, S. pneumoniae carriage rates determined in healthy children were high and PNSSP strains also showed increased resistance to other antimicrobials.