Red Cross Children Research Articles

Abdominal wall and psoas abscesses in children

Seventy-seven cases of pyogenic abdominal wall abscess and 33 cases of psoas abscess admitted to the Red Cross Children's Hospital are reviewed separately. The difficulty encountered in diagnosis, particularly in deep-seated abdominal wall abscesses, is emphasised as resulting in delays in treatment. Ultrasound accurately delineated the abscess in 80% of cases submitted for this investigation. Surgical drainage proved effective therapy, and Staphylococcus aureus was the causative organism in more than 80%. No long-term sequelae were encountered.

Abdominal complications of Ascaris lumbricoides in children

Human infestation with Ascaris lumbricoides is common in tropical and subtropical areas and is responsible for 20% of acute admissions annually to the surgical wards of the Red Cross Children's Hospital. Of the 225 children with symptomatic ascariasis seen during the 5-year period 1985–1989, 66% were intestinal, 30% hepato-biliary, and 4% pancreatic. Real-time ultrasound was the method of choice for diagnosis of invasion of the biliary and pancreatic systems. Eighty-four per cent resolved within 3 days after a short transient illness. Endoscopic retrograde cholangio-pancreatography was performed 15 times in 13 children when conservative measures failed and hepato-biliary infestation persisted. Complete removal of common bile duct worms was achieved in 55%. Thirty-seven (16%) were operated upon for deteriorating intestinal obstruction or persistent biliary and complicated hepatic disease. Indications for surgery are suspicion of ischaemic bowel, persistence of common bile duct worms for more than 4–6 weeks, liver disease, and persisting pseudocyst of the pancreas.

Diaphyseal Primary Subacute Osteomyelitis in Children

Six patients with subacute diaphyseal osteomyelitis of 200 with acute osteomyelitis who were seen and treated at the Red Cross Children's Hospital in a 3-year period (1985-1987) are reported. All six patients had a history of a minimum of 2 weeks' duration and the radiographic picture of a linear periosteal reaction, which was either single or laminated. This radiographic picture was indistinguishable from round cell tumors of bone. The final diagnosis was established by a histology consistent with a subacute osteomyelitis. In two patients, a positive culture of Staphylococcus aureus was obtained. All of the patients healed after treatment with cloxacillin. Radiographic resolution was noted in all patients within 6 months of treatment.

Circumcision in South Africa

Still remains the commonest reason. The arguments for requesting circumcision by the mother are the same as outlined by King and coauthors. In this country most circumcisions are performed privately. In our public hospitals, circumcision are supposed to be performed only for medical reasons. The following are the statistics from the Red Cross War Memorial Children's Hospital and the Mowbray Maternity Hospital in Cape Town, both teaching hospitals of the University of Cape Town. During a 4-year period 1985-1988, 276 circumcisions were performed at the Red Cross Children's Hospital. The ages ranged from 3 months to l0 years none in the neonatal period. The reasons for circumcision and the complications are shown in Table 1. Despite the policy in our public hospitals of performing circumcisions for medical reasons only, the most common reason was request by mother and several were for Muslim ritual reasons. There were 30 referrals for complications following a circumcision performed elsewhere. There were 40 complications, as shown in Table 1, for which 32 revision circumcisions were

Tracheostomy in children — The Red Cross War Memorial Children's Hospital experience 1980–1985

During the 6 years (1980–1985) at The Red Cross Children's Hospital 293 children required a tracheostomy during treatment of a variety of disorders. Of these children 44% were under 1 year of age. Indications are discussed of which the commonest was LTB. Of the 3500 children seen with laryngotracheobronchitis (LTB) 4.6% had a tracheostomy—28% of those requiring airway intervention. Overall 67% of the children were decannulated within 10 weeks and 92% within a year. For 56% one or more further procedures prior to decannulation were required, including 34 children who required a laryngotracheoplasty. Obstructing stomal granulation tissue had to be removed from 51 children and suprastomal collapse was a cause of decannulation failure in 52 children. Use of an expiratory valve as an aid to decannulation is discussed. Five children died of tracheostomy airway complications and 25 children of a medical disorder. One complication, laryngeal incompetence, was particularly associated with herpetic laryngeal ulceration. Staphylococcus aureus and Hemophilus influenzae were the main organisms cultured in the early weeks, with Pseudomonas and Streptococcus species predominating later.

Pelvic rhabdomyosarcoma in children

From 1961 to 1986, 29 patients with pelvic rhabdomyosarcoma (including pelvic retroperitoneal rhabdomyosarcoma) were admitted to the paediatric surgical service at the Red Cross Children's Hospital, Cape Town. During the period 1961–1970, the mainstay of treatment was radical surgery with or without subsquent chemotheraphy and radiotherapy. Of the 13 patients, only 2 have survived long-term (15%). From 1971 a new management policy of pre-treatment with chemotherapy and in some instances radiotherapy followed by conservative limited surgery was commenced. Twelve of the 16 patients have survived (75%). One patient with stage III prostatic tumour had treatment with only chemotherapy and radiotherapy and is surviving 8 years after diagnosis; another with a vaginal tumour, also stage III, whose parents refused surgery is alive tumour-free 4 years after similar treatment. Chemotherapy has not only significantly improved survival in pelvic rhabdomyosarcoma but has permitted limited surgery and in some instances has resulted in survival without surgical excision.

Cloacal exstrophy: a long-term follow-up with faecal continence

Of 24 infants with cloacal exstrophy admitted to the Red Cross Children's Hospital in Cape Town since 1956, 8 underwent surgery. Six died after the first phase of surgical repair, and only 2 have survived long-term. A 19-year follow-up of these 2 patients is described. One of them has had a remarkable end-result, with complete faecal continence and a palpable sphincter. She had an exstrophied colonic field, in contrast to the caecal plate found in the majority of cases. Although she had vertebral and sacral abnormalities, there was no evidence of myelomeningocoele. An ileal urinary conduit was performed after excision of the exstrophied half of the bladder. She has developed fully as a female and has not required genital re-construction. Our second patient followed the usual pattern in that she has severe neurological deficits due to the myelomeningocoele, a urinary conduit, and a colostomy. She has been reared as a female after removal of intra-abdominal testes. Although she is on replacement oestrogen therapy, she has not has genital reconstruction as yet. Some of the theories on aetiology are mentioned and the operative procedures are outlined.

Distribution of sero-biotypes of Campylobacter jejuni and C. coli isolated from paediatric patients.

During a one-year period, 258 isolates of Campylobacter jejuni and C. coli were obtained from children with gastroenteritis or bacteraemia at the Red Cross Children's Hospital, Cape Town, South Africa. These isolates were biotyped by hippurate hydrolysis, H2S production and tolerance to 2,3,5-triphenyltetrazolium chloride (TTC). Our study indicated that 95.4% of the isolates were C. jejuni biotype 1, 1.5% were C. jejuni biotype 2 and 3.1% were C. coli; 70% of the isolates were resistant to TTC. Serotyping on the basis of soluble, thermostable antigens detected by a passive-haemagglutination technique revealed that 79% of the Cape Town isolates were typable and that the most common serotypes, in order, were: 4, 2, 12, 23/36 and 19, together comprising 25% of the isolates. About 37% of the typable isolates belonged to nine serotypes. The finding that 21% of the isolates were non-typable suggests the existence of antigenic specificities different from those defined by the 60 antisera in current use.

Concept of a paediatric emergency ward for the cities of a developing country.

Children's hospitals in developing countries carry an enormous patient load. Available facilities must be organized to provide essential care for all. At the Red Cross Children's Hospital in Cape Town this has been achieved by the development of an emergency ward attached to the outpatient department. It is suggested that this concept should be applied in large hospitals of other developing countries.

Child Abuse: A Crisis Intervention Approach

Abstract The growing number of reported child abuse cases continues to pressure the South African social services. The present scenario demands that creative ways of helping the child survivor and family be investigated. Substantiated by relevant statistics, this paper will advocate the crisis intervention approach as a means of dealing with child abuse cases in South Africa today. Various applications of the crisis intervention approach will be explained, which may be useful with the abused child. It is suggested that this approach, which has been implemented by the author at the Red Cross Children's Hospital in Cape Town, may facilitate both the healing and the prevention of mental illness in relation to child abuse.

Malignant diseases in children

Summary A survey is presented of malignant disease occurring in children seen at Groote Schuur Hospital and Red Cross Children's Hospital, Cape Town, from 1952 to 1961.