[Management of fever in children]. / Wenn die Kleinsten Fieber haben.

Fever is one of the most common reasons for encounter in pediatrics. This article gives information on how to judge the condition of a feverish child or infant correctly: Special emphasis should be put on the general condition of the patient and the clinical course of symptoms over time. With a few skills and tools severe pitfalls can be avoided. General practitioners administer antibiotics in febrile children more often than pediatricians do. The decision of giving antibiotics in an ambulatory setting should not exclusively be based on elevated inflammatory markers in the blood without a sufficient clinical proof of bacterial infection. Also normal lab results can be misleading and are no proof of absence of severe infection. Rapid deterioration in the child's condition without a proper response to NSAID or acetaminophen is a primary warning sign and parents should always be encouraged to have their child rejudged immediately in that case. This applies especially to young children. The option of a follow up encounter should always be offered to parents when dismissing them.

Predictors of general complications after video-assisted thoracoscopic surgical procedures.

BACKGROUND: The video-assisted thoracoscopic approach has become the preferred method for many procedures due to the reduced trauma, complication rate and morbidity. The aim of this study was a risk evaluation of patients undergoing video-assisted thoracoscopic surgery (VATS) procedures. METHODS: Between 1991 and 2004, 1,008 patients were included in this single-center retrospective analysis. Risk assessment was performed using univariate and multivariate analysis. RESULTS: Multivariate analysis revealed that patient age (p = 0.003), the duration of the VATS procedure (p = 0.008), redo-VATS (p < 0.001) and conversion to open thoracotomy (p < 0.001) correlated significantly with the incidence of complications. Patients with immune deficiency following organ transplantation had the highest complication rate at 31.7%, which was significantly higher than for patients with either benign disease (p = 0.010) or malignant disease (p = 0.019). CONCLUSIONS: VATS is a safe procedure, but extra caution is recommended for patients with a higher risk profile (age, redo-VATS, immune deficiency).