Coincidence of immune thrombocytopenia, intracranial hemorrhage and graft-versus-host disease in an 11-year-old girl.

Primary immune thrombocytopenia (ITP) in children is usually self-limiting and harmless but can, rarely, result in life-threatening complications. The case of an 11-year-old girl with ITP is presented who developed recurrent intracranial hemorrhages followed by cerebral infarctions. The clinical course was complicated by a graft-versus-host disease involving several organs. Treatment was performed according to the current international consensus report of 2010 with glucocorticoids, immunoglobulin G, anti-D-immunoglobulin and additionally embolisation of the splenic artery. The girl survived. Reliable predictors, preventive measures for life-threatening complications in ITP and more information about the effectiveness and side-effects of the recommended treatment are urgently needed.

Lethal influenza B myocarditis in a child and review of the literature for pediatric age groups.

CASE PRESENTATION: We report on the case of a 5 year-old girl who developed fulminant myocarditis due to acute infection with influenza virus type B. Cardiac arrest occurred suddenly, resuscitation efforts were not successful, and the patient died of congestive heart failure 24 h after admission to the hospital. DIAGNOSIS: Lymphocytic infiltration of cardiac tissues and virologic studies confirmed the suspected diagnosis of acute viral myocarditis. CONCLUSION: In conclusion, influenza virus type B is one of the infective agents that can cause rapid and fatal myocarditis in previously healthy children. Early cardiac support may be the only option to prevent fatal outcome.

Etilefrinhydrochloride tablet ingestion: successful therapy by endoscopic removal of tablet conglomerate.

We report here on a case of etilefrinhydrochloride tablet intoxication in suicidal intention in a female adolescent. Tablet ingestion resulted in the formation of a tablet conglomerate in the stomach, which could neither be effectively treated with activated charcoal nor by gastric lavage. Endoscopic dissemination and removal of the fragments finally led to the elimination of the tables and the symptoms of intoxication resolved completely. The case presented here offers an explanation as to why the use of activated charcoal and/or a gastric lavage may not be successful in some cases of ingestion/intoxication. Endoscopic removal of ingested fragments of the toxic substance, such as etilefrinhydrochloride tablets, may be useful even hours following ingestion and should be considered when treatment with activated charcoal or gastric lavage fail to eliminate toxic substances in cases of tablet ingestion.

[Adder bites--clinical picture, diagnosis and management]. / Kreuzotterbisse--Klinik, Diagnostik und Behandlung.

Adder bites are occasionally occurring envenoming emergencies. More than ten percent of the clinical courses are severe and even life-threatening. Children and elderly patients are over-represented in this group. Common symptoms comprise local edema, abdominal pain and vomiting, arterial hypotension and neurological disorders. First steps in the management are immobilization of the affected extremity, reassurance of the patient and application of analgetics. Anaphylaxis may occur and requires status adapted treatment. Persistent circulatory shock, protracted gastrointestinal or severe neurological symptoms, as well as rapidly progressing edema and airway obstruction are indications for antivenom treatment. Administration of antivenom results in prompt clinical improvement and in a significantly shorter hospital stay.

[Acute ethanol intoxication among children and adolescents. A retrospective analysis of 173 patients admitted to a university children hospital]. / Alkoholintoxikation bei Kindern und Jugendlichen. Eine retrospektive Analyse von 173 an einer Universitätskinderklinik betreuten Patienten.

BACKGROUND: In the last time the alcohol consumption among children and adolescents is a big theme in all kind of media. The ethanol consumption among children and adolescents has risen during the last years, but also new hazardous drinking patterns like "binge-drinking" are increasing. These drinking episodes are responsible for many hospital presentations of children and adolescents with acute ethanol intoxication. PATIENTS AND METHODS: This study is a retrospective analysis of 173 patients admitted to the university children hospital of Leipzig due to acute ethanol intoxication during the period 1998-2004. Investigated parameters were: socio-demographic factors, clinical presentation and management as well as quantity and type of alcohol. RESULTS: During the years 1998-2004 the rate of alcohol intoxicated patients in this study increased, from 1998-2003 at about 171.4%. Totally 173 patients with an average age of 14.5 years were admitted to the university children hospital. There were significantly more boys than girls. The mean blood alcohol concentration of these patients was 1.77%. Some of the patients had severe symptoms. 62 were unconscious, 2 were in coma and at least 3 patients had to be ventilated. A difference between socioeconomic groups could be observed by comparing the different school types. 44.8% of the patients went to the middle school. Furthermore 17 patients of this study had mental disorders or psychosocial problems and were therefore in psychological or psychiatric treatment. CONCLUSIONS: In this study a significant influence of social classes or psychosocial problems on alcohol consumption such as binge-drinking leading to acute ethanol intoxication could not be found. Alarming is the increasing number of ethanol intoxicated patients, the young age, the high measured blood ethanol concentrations and the severe symptoms of these patients. This is the reason why early and intensive prevention strategies are required.

An esophagobronchial fistula caused by an unusual foreign body in the esophagus leading to mediastinitis with fatal outcome.

An 8(10)/(12) year old girl with infantile cerebral paresis (ICP), severe mental retardation and seizure disorder was admitted to the intensive care unit (ICU) with clinical signs of aspiration and died ten days later. Final diagnosis was esophagobronchial fistula caused by a foreign body in the esophagus provoking aspiration pneumonia, mediastinitis and respiratory distress syndrome (ARDS). The foreign body was found to be part of a plastic toy. The clinical relevance of aspiration in mentally retarded children and the peculiar nature of the foreign body impacted in the esophagus in this case are discussed. We conclude that in cases of aspiration pneumonia in mentally retarded children the presence of unusual foreign bodies should be suspected.

Treatment of transient posttraumatic bile-duct stenosis by laparoscopic-assisted cholecystotomy.

A 10-year-old boy developed severe obstructive jaundice following blunt abdominal trauma. Endoscopic retrograde cholangiography and magnetic resonance cholangiography revealed a stricture of the common bile duct. A cholecystostomy tube was inserted under laparoscopic guidance. After temporary bile drainage and a cholecystoenteric bypass the patient recovered.

Neurocardiogenic syncope in a 10-year-old boy.

We present a case with a suspected epileptic disorder. This may be a result of a neurocardiogenic syncope leading to seizures. A 10-year-old boy suffered two episodes of sudden loss of consciousness after getting injections. Electrocardiography (ECG) and electroencephalography recordings during a venipuncture showed asystole of 6 seconds followed by a generalized seizure with clonic jerks of the right arm and leg while theta waves in the EEG were noted. Tilt-table testing could not provoke a pathological reaction.

Beta-blocker therapy of severe congestive heart failure in infants with left to right shunts.

We report on the clinical and neurohumoral effects of adding low-dose propranolol to conventional therapy with digoxin and diuretics in 6 infants with severe congestive heart failure due to large left-to-right shunts. A significant decrease in heart failure scores and a decrease of the highly activated renin-angiotensin-1 aldosterone system by approximately 70% strongly suggests a beneficial effect of this new therapeutic approach.

Tetralogy of Fallot in three sibs.

We report on three sibs (2 boys, one girl) with tetralogy of Fallot from non-consanguineous parents. The first child died during corrective surgery in 1972 from irreversible right ventricular failure. Corrective surgery was successful in the 2nd son and the daughter. The occurrence of tetralogy of Fallot in 3 sibs suggests a recessive gene.