Treatment In Older Children Research Articles

ПАТОГЕНЕТИЧЕСКАЯ ТЕРАПИЯ СЕРДЕЧНО-СОСУДИСТЫХ НАРУШЕНИЙ У ДЕТЕЙ СТАРШЕГО ВОЗРАСТА И ПОДРОСТКОВ, БОЛЬНЫХ ТУБЕРКУЛЕЗОМ ОРГАНОВ ДЫХАНИЯ С МЛУ/ШЛУ МБТ

We carried out a cohort retrospective-prospective study in order to evaluate the impact of pathogenetic therapy of cardiovascular disorders (CVD) on bedaquiline (Bq) containing TB treatment in older children and adolescents with multi or extensively drug resistant (MDR/XDR) pulmonary TB. The study included 51 patients aged 13–17 years with pulmonary TB and established MDR/pre-XDR/XDR hospitalized in 2014–2023. The prospective study included 35 patients (main group), and the retrospective study included 16 patients (control group). The main group was administered correction of CVD due to QTc interval prolongation without Bq withdrawal; in the control group Bq was withdrawn (according to the current clinical recommendations). We established conduction disturbances in the form of QTc interval prolongation in both main and control groups, 45.7 and 18.7% respectively. In the control group QTc interval prolongation, which required Bq withdrawal, was observed in 3 out of 16 cases. The analysis of proarrhythmogenic factors and comprehensive ECG monitoring in the main group established functional nature of the changes (slow QTc interval adaptation to heart rate changes) in 16 out of 35 cases. Due to pathogenetic therapy (replacement, metabolic therapy, use of β-adrenoblockers) aimed to mitigate the impact of proarrhythmogenic factors we managed to neutralize signs of electrical instability of the heart and continue Bq containing treatment. The comparison of the frequency of Bq withdrawal between the groups associated with correction due to CVD established a significant correlation between the studied risk factor and the outcome (withdrawal of Bq) (χ2 = 3.997; p < 0.05). Thus, our study demonstrated that timely target correction of modifiable risk factors reduced the probability of drug-induced arrhythmia and allowed safe administration of TB drugs with potential cardiotoxic effect.

Seguimiento a muy largo plazo tras implante de stent en la coartación de aorta

Introduction and objectivesStent implantation is the preferred treatment in older children and adults with aortic coarctation (CoA). We aimed to determine the incidence of very late events after CoA stenting. MethodsWe analyzed a cohort of CoA patients who underwent stent implantation at our center between 1993 and 2018. Patients were periodically followed up in outpatient clinics, including computed tomography (CT) and fluoroscopy assessment. ResultsA total of 167 patients with CT and fluoroscopy data were included: 83 (49.7%) were aged ≤ 12 years and 46 (28%) were female. The mean clinical follow-up time was 17±8 (range 4-30) years and the mean time to CT/fluoroscopy was 11±7 years. Aortic aneurysm was present in 13% and was associated with the PALMAZ stent (OR, 3.09; 95%CI, 1.11-9.49; P=.036) and the stented length (OR, 0.94; 95%CI, 0.89-0.99; P=.039). Stent fracture was frequent (34%), but was not related to the presence of aneurysm. Stent fracture was associated with young age (OR, 3.57; 95%CI, 1.54-8.33; P=.003), male sex (OR, 4.00; 95%CI, 1.51-12.5, P=.008) and inversely with the PALMAZ stent (OR, 0.29; 95%CI, 0.12-0.67, P=.005). Reintervention was lower in adults (10%), mainly related to aneurysms. Those treated when aged ≤ 12 years had higher reintervention rates (43%) due to recoarctation somatic growth. ConclusionsThis long-term follow-up study of CoA patients treated with stenting revealed a significant incidence of late events. Reintervention rates were higher in patients treated at younger ages. Periodic imaging surveillance appears to be advisable.

Very long-term follow-up after aortic stenting for coarctation of the aorta

Introduction and objectivesStent implantation is the preferred treatment in older children and adults with aortic coarctation (CoA). We aimed to determine the incidence of very late events after CoA stenting. MethodsWe analyzed a cohort of CoA patients who underwent stent implantation at our center between 1993 and 2018. Patients were periodically followed up in outpatient clinics, including computed tomography (CT) and fluoroscopy assessment. ResultsA total of 167 patients with CT and fluoroscopy data were included: 83 (49.7%) were aged ≤ 12 years and 46 (28%) were female. The mean clinical follow-up time was 17±8 (range 4-30) years and the mean time to CT/fluoroscopy was 11±7 years. Aortic aneurysm was present in 13% and was associated with the PALMAZ stent (OR, 3.09; 95%CI, 1.11-9.49; P=.036) and the stented length (OR, 0.94; 95%CI, 0.89-0.99; P=.039). Stent fracture was frequent (34%), but was not related to the presence of aneurysm. Stent fracture was associated with young age (OR, 3.57; 95%CI, 1.54-8.33; P=.003), male sex (OR, 4.00; 95%CI, 1.51-12.5, P=.008) and inversely with the PALMAZ stent (OR, 0.29; 95%CI, 0.12-0.67, P=.005). Reintervention was lower in adults (10%), mainly related to aneurysms. Those treated when aged ≤ 12 years had higher reintervention rates (43%) due to recoarctation somatic growth. ConclusionsThis long-term follow-up study of CoA patients treated with stenting revealed a significant incidence of late events. Reintervention rates were higher in patients treated at younger ages. Periodic imaging surveillance appears to be advisable.

Transcatheter closure of ventricular septal defects in children less than 10 kg: experience from a tertiary care referral hospital in Eastern India

To assess the feasibility of percutaneous transcatheter device closure of ventricular septal defects in children weighing less than 10 kg. Although percutaneous transcatheter device closure of ventricular septal defect is a well-established method of treatment in older children and adolescents, there is limited data on device closure in small children weighing less than 10 kg. We present our institutional experience of transcatheter VSD closure in children weighing less than 10 kg. Medical records were reviewed for 16 children, who were selected for device closure of ventricular septal defects based on the inclusion criteria. Out of 65 patients with a diagnosis of ventricular septal defect, 16 children less than 10 kg were attempted for percutaneous device closure. In 13 patients, the device was successfully released, and 3 patients needed surgical closure of the defect. Mean age and weight of the patients were 17.3 ± 12.7 months and 6.8 ± 3.2 kg, respectively. Mean defect size was 6 mm (range 3-10). There was no incidence of device embolisation or heart block or death. Five patients had residual left-to-right shunt immediately after the device release, which got closed by the first month's follow-up. We had one accidental perforation of right ventricular free wall at the time of crossing of the defect, which was successfully repaired surgically. Percutaneous device closure of ventricular septal defect in small children with weight below 10 kg is feasible with good short-term outcome. Careful patient selection is essential for procedural success and to avoid complications.

Acute aortic dissection as a late and fatal complication of transcatheter persistent ductus arteriosus occlusion: a case report.

Background Persistent ductus arteriosus (PDA) is a common congenital heart defect, of which, the preferred treatment in children and adults is transcatheter occlusion. This report describes the first reported case of acute aortic dissection as a late complication of transcatheter PDA occlusion.Case summary A 66-year-old healthy woman, with a history of transcatheter PDA closure 12 years previously, died suddenly at home. Post-mortem revealed pericardial tamponade complicating an acute aortic dissection, with a large intimal tear identified adjacent to the PDA occluder.Discussion Transcatheter occlusion is accepted as a safe and effective treatment in older children and adults, important in preventing haemodynamic sequelae such as heart failure and pulmonary hypertension. Complications are uncommon and mostly acute, including device embolization and haemolysis. Aortic dissection has been reported as an acute complication but only in the setting of incorrect device deployment. This is the first description of aortic dissection as a late complication of transcatheter PDA occlusion and although rare has important ramifications given it is a potentially fatal outcome of a common procedure.

Early and late outcome of covered and non-covered stents in the treatment of coarctation of aorta- A single centre experience

ObjectiveStenting of coarctation of aorta with covered or uncovered stents is the accepted modality of treatment in older children and adults. The indications which mandate the use of covered stents are still unclear. We attempted to study the early and late outcomes after stenting of native and recurrent coarctation of aorta with uncovered and covered stents. MethodThis is a retrospective study of patients who underwent stenting for coarctation of aorta with covered or non-covered stents at our institute. Early and late outcome for both the groups were studied. ResultsTwenty patients underwent implantation of covered stent and twenty five patients had uncovered stent implantation. Patients in the covered stent group were older and had greater basal pressure gradient. More patients in the covered stent group had residual gradient >10 mm Hg after the procedure. There was no mortality or aortic wall injury in either group. Four patients in the covered stent group underwent planned re-intervention and two had unplanned re-intervention. None of the patients in the uncovered stent group had re-intervention. Higher incidence of late lumen loss was noted in the covered stent group. ConclusionUncovered stents can be safely implanted with minimal risk of aortic wall injury in patients with low risk anatomic features. Covered stent implantation is associated with higher incidence of planned and unplanned re-intervention.

Acetabular reaming and sartorius muscle pedicle iliac bone grafting in the treatment of developmental dysplasia of the hip in older children: a retrospective study of 15 patients with more than two years follow-up.

PurposeDespite the early diagnosis and treatment of developmental dysplasia of the hip (DDH), some older children still need open reduction. It is usually difficult to get a satisfactory reduction particularly in patients with acetabular defect. The purpose of this study was to evaluate the short-term outcomes of acetabulum reaming and sartorius muscle pedicle iliac bone grafting in the treatment of older children with DDH and acetabular defect.MethodsThe records of 15 patients with DDH (mean age 113.9 months (sd 29); 17 hips) who were treated with the reported technique between February 2015 and January 2017 were retrospectively reviewed. All patients acquired regular clinical and radiographic follow-ups, and alterations in the acetabular index, centre-edge angle and acetabular head index were measured. Joint function and radiographic results were evaluated with McKay and Severin modified criteria, respectively.ResultsA total of 15 patients were followed up for mean 32.4 months (sd 6.9). The percentages of excellent and good conditions were 94.1% (16/17) according to the Severin modified criteria and 88.2% (15/17) according to the McKay modified criteria. Avascular necrosis of the femoral head and redislocation only occurred in one hip. No cases of ankylosis or bone graft absorption occurred during the follow-up.ConclusionReaming the acetabulum and sartorius muscle pedicle iliac bone grafting for repairing the acetabular defect can recover the arcuate structure by increasing the volume of the acetabulum, which is beneficial for achieving a concentric reduction. The short-term outcome was satisfactory, while the long-term results need to be further observed.Level of EvidenceIV – retrospective study

Temporal Variation of Scores Along the Course of the Ponseti Treatment in Older Children: A Ready Guide to Progress of Treatment.

We aimed to graphically study the correction trend along the course of Ponseti treatment in older children with idiopathic clubfeet. The temporal variation of total Pirani and Dimeglio scores and their individual components at each casting session was represented graphically. Tenotomy correction was accounted for separately. We classified 0 to 4 as early, 4 to 8 as midlevel, and beyond 8 as late casts to describe the sequence of treatment. A total of 27 patients (39 feet; bilateral in 12) were studied. The average patient age was 4.78±2.36 years. Rigid equinus was the more severe pretreatment deformity in Pirani system and also the most difficult to treat component. Posterior crease and medial crease were least severe and were treated in early casts. Reducibility of lateral head of talus, curved lateral border of foot, and empty heel were moderately severe and showed a gradual improvement pattern over subsequent casting sessions. For Dimeglio components, equinus was the most resistant deformity, and it persisted until late casts. Adduction, rotation, and varus were moderately severe, and they followed a gradual improvement slope. Several components/scores did not turn 0 after correction for older clubfoot children. The treatment graphs for older clubfoot children adequately illustrated the initial severity, number of Ponseti casts used, correction of total scores and their individual components over sequential casting sessions, tenotomy influence, and the residual deformities.

Epidemiology and prognostic factors of infantile malignant solid tumor

As an important part of childhood tumors, infantile malignant solid tumor is relatively rare, which has some common characteristics of childhood cancer as well as its own particularity.Most infantile tumors are embryo-derived tumors, whose pathogenesis is related to developmental biology, genetics and environmental factors.The distribution of constituent ratio of infantile malignant tumors is different from that of older children, and the epidemiological data statistics can be influenced by the imperfect children tumor registration system, population migration, birth defects and perinatal factors, environmental exposure, gender, race and other factors.Heterogeneity is one of the prominent features of malignant solid tumor in infants. The experience gained from treatment of older children cannot be directly extrapolated to infants.The principle of treating infantile malignant solid tumors should take into account both the effectiveness and the long-term impact on infant growth.Early diagnosis and appropriate treatment mean that the prognosis of most infants with malignant solid tumor to be better than that of older children.Therefore, it is necessary to manage these tumors as a separate entity.The advance of epidemiology and prognostic factors of infantile malignant solid tumors at home and abroad was reviewed in this paper. Key words: Infant; Malignant; Solid tumor; Incidence rate; Constituent ratio; Prognosis

Older Patients May Have More Frequent Seizures among Children Diagnosed as Benign Convulsions with Mild Gastroenteritis.

Benign convulsions with mild gastroenteritis (CwG) is a condition that does not usually require treatment. However, when the patient experiences multiple seizures or prolonged seizures, anticonvulsant treatment may be required. We investigated this study to identify the factors that may influence on the number or duration of seizures at CwG. We retrospectively analyzed the medical records of CwG patients who were admitted to the Department of Pediatrics at Sanggye Paik Hospital. A total of 105 children with CwG were enrolled. The mean age was 19.59 ± 7.09 months. The mean duration of seizure was 2.79 ± 5.51 minutes and mean number of seizure was 2.33 ± 1.70. Sixty-nine children had seizures less than twice, whereas 36 experienced three times or more. These groups differed significantly according to age in CwG (18.16 ± 7.08, vs. 22.33 ± 6.34 months, p < 0.05). When patients were divided into two groups based on age in CwG using a cut-off of 20 months, we found significant differences in seizure number (1.91 ± 1.27 vs. 3.11 ± 2.10, p < 0.05). There was also a positive correlation between patient age and frequency of seizures (R = 0.316, p = 0.001). Patients who received anticonvulsants were older (17.60 ± 6.87 vs. 22.04 ± 6.63 months, p < 0.05) and had more frequent (1.59 ± 1.37 vs. 3.26 ± 1.63, p < 0.05) and longer seizures (1.76 ± 2.75 vs. 4.07 ± 7.49 minutes, p < 0.05). As the number of seizure in CwG was associated with age, treatment in older children may be required in acute stage.

'It's too late'. Is it really? Considerations for amblyopia treatment in older children.

In recent years, media coverage has demonstrated instances in which families of children aged 7 and older, newly diagnosed with strabismic and/or anisometropic amblyopia through community eyecare services, were told it was ‘too late’ for their child to effectively respond to conventional amblyopia treatment (occlusion or atropine penalisation). Formal guidance pertaining to binocular vision anomalies from eyecare professional bodies does not specifically make reference to a child’s age, beyond stating the importance of early diagnosis and treatment of strabismus/amblyopia. However, there have been many changes in the way we view the recovery period for amblyopia, and it is well demonstrated both within literature and clinical practice that conventional treatment can improve amblyopic eye visual acuity in children beyond the age of 7 years. The occurrence of these media described cases within the community eyecare sphere would suggest it is worthwhile revisiting the literature on the subject of amblyopia treatment in older children (aged 7+ years), to address misconceptions and place in the spotlight current considerations facing clinicians when treating newly diagnosed amblyopia within this age group. This perspective review provides an evidence-based update covering the various considerations associated with treatment of amblyopia in older children, along with recent amblyopia treatment advances that could have an impact on treatment prospects for this patient group. Considerations include the risks, benefits and efficacy of treating newly diagnosed amblyopia in older children, monitoring density of suppression to mitigate intractable diplopia risk, and recent findings regarding binocular treatments for amblyopia.

Intravenous magnesium sulfate for acute wheezing in young children: a randomised double-blind trial.

Magnesium sulfate has been shown to be an effective treatment in older children with asthma exacerbations, but it has not been investigated in acute severe virus-induced wheezing in young children.The study enrolled 61 children aged 6 months to 4 years. Inclusion criteria were severe wheezing, classified as a score of ≥6 points as assessed by the Respiratory Distress Assessment Instrument (RDAI) after initial treatment with salbutamol, and the symptoms of acute viral infection. The children were randomly allocated to receive either an infusion of magnesium sulfate (40 mg·kg-1) or 0.9% sodium chloride as a placebo infusion for 20 min. Primary outcome measure was mean change in RDAI scores from baseline to 6 h after the treatment.Change in the severity of wheezing from baseline to 6 h after the treatment, as measured by mean±sd RDAI scores, was 4.7±2.6 in the magnesium sulfate group and 4.2±4.2 in the placebo group (difference 0.5, 95% CI -1.3 to 2.3, p=0.594).Intravenous magnesium sulfate was ineffective in treating acute severe virus-induced wheezing in young children, in contrast to the previous efficacy demonstrated in older children.

Epidemiology and Outcomes of Arterial Ischemic Stroke in Children: The Canadian Pediatric Ischemic Stroke Registry

BackgroundPediatric arterial ischemic stroke remains incompletely understood. Population-based epidemiological data inform clinical trial design but are scant in this condition. We aimed to determine age-specific epidemiological characteristics of arterial ischemic stroke in neonates (birth to 28 days) and older children (29 days to 18 years). MethodsWe conducted a 16-year, prospective, national population-based study, the Canadian Pediatric Ischemic Stroke Registry, across all 16 Canadian acute care children's hospitals. We prospectively enrolled children with arterial ischemic stroke from January 1992 to December 2001 and documented disease incidence, presentations, risk factors, and treatments. Study outcomes were assessed throughout 2008, including abnormal clinical outcomes (stroke-related death or neurological deficit) and recurrent arterial ischemic stroke or transient ischemic attack. ResultsAmong 1129 children enrolled with arterial ischemic stroke, stroke incidence was 1.72/100,000/year, (neonates 10.2/100,000 live births). Detailed clinical and radiological information were available for 933 children (232 neonates and 701 older children, 55% male). The predominant clinical presentations were seizures in neonates (88%), focal deficits in older children (77%), and diffuse neurological signs (54%) in both. Among neonates, 44% had no discernible risk factors. In older children, arteriopathy (49% of patients with vascular imaging), cardiac disorders (28%), and prothrombotic disorders (35% of patients tested) predominated. Antithrombotic treatment increased during the study period (P < 0.001). Stroke-specific mortality was 5%. Outcomes included neurological deficits in 60% of neonates and 70% of older children. Among neonates, deficits emerged during follow-up in 39%. Overall, an initially decreased level of consciousness, a nonspecific systemic presentation, and the presence of stroke risk factors predicted abnormal outcomes. For neonates, predictors were decreased level of consciousness, nonspecific systemic presentation, and basal ganglia infarcts. For older children, predictors were initial seizures, nonspecific systemic presentation, risk factors, and lack of antithrombotic treatment. Recurrent arterial ischemic stroke or transient ischemic attack developed in 12% of older children and was predicted by arteriopathy, presentation without seizures, and lack of antithrombotic treatment. Emerging deficit was predicted by neonatal age at stroke and by cardiac disease. ConclusionsThis national data set provides a population-based disease incidence rate and demonstrates the protective effect of antithrombotic treatment in older children, and frequent long-term emerging deficits in neonates and in children with cardiac disorders. Further clinical trials are required to develop effective age-appropriate treatments for children with acute arterial ischemic stroke.

Factors Associated with Malaria Prevalence among Children under Five Years in the Hohoe Municipality of Ghana

Background: Malaria continues to adversely impact the health of children in Ghana. Hohoe is an area of intense and prolonged, seasonal malaria transmission and malaria is still the leading cause of morbidity and mortality among children under five years. This study was set out to determine factors associated with malaria infection among children less than five years. Method: An unmatched case-control study was conducted in November 2015 involving children less than five years from 30 communities. Information on the background characteristics of the children and parents/guardians were collected using a pretested questionnaire. Children were screened to determine their malaria infection status using finger prick blood for RDT. Anthropometric indices and axillary temperature were measured, as well as blood film for malaria parasites and haemoglobin levels. T-test was used for means and Odds Ratios was used to determine the relationships and associations between the dependent and independent variables. Results: Out of 1697 children screened, 676 (39.8%) tested positive with RDT (cases) and 1,021 tested negative (controls). Older children aged 24-35 and 36-47, and 48 months and above were more likely to have malaria as compared to the younger age group 6-11 months (OR=1.66 (95% CI: 1.04-2.65); p=0.034), (OR=1.77 (95% CI: 1.10-2.87); p=0.019) and (OR=2.02 (95% CI: 1.24-3.29); p=0.005), respectively. Current fever, History of fever within one week and antimalarial drug use at home were 3.07, 1.75 and 4.03 times more likely to occur among cases than in the controls (OR=3.07 (95% CI: 1.21-7.81); p<0.018), (OR=1.75 (95% CI: 1.29-2.37); p<0.001) and (OR=4.03 (95% CI: 2.82-5.77); p<0.001), respectively. Anaemia (HB<11.0g/dL) was 1.87 times more likely among the cases than in the controls (OR=1.87 (95% CI: 1.40-2.48); p<0.001). Children of parents/guardians who were farmers and traders were more likely to have malaria (OR=1.73 (95% CI: 1.16-2.56); p=0.007) and (OR=1.83 (95% CI: 1.22-2.74); p=0.003), respectively. Conclusion: Age, current fever, history of fever within one week, anaemia, use of antimalarial drugs at home and parent/guardian’s occupation were factors associated with malaria infection. Targeted screening and treatment of older children and intensive education on malaria prevention in addition to the current control activities could serve as tools for controlling malaria to the level of elimination.

Transcatheter/Hybrid Aortic Valves in the Young

Transcatheter aortic valve implantation (T-AVI) has been established as an alternative to conventional aortic valve replacement. The number of procedures is steadily rising and has reached comparable implant rates to conventional aortic valve replacement. The success of T-AVI is easily explained by their true minimally invasive nature, ease of use, and excellent hemodynamics. Whilst their use was initially limited to high-risk patients, current trends show that more and more intermediate-risk patients are now treated with theses prostheses. The question arises whether children would also benefit from this type of procedure. Percutaneous transcatheter pulmonary valve replacement is already becoming an important adjunct in the treatment of older children with failing right ventricular outflow tract conduits. Recently, several valve-in-valve procedures have been performed using T-AVI in failing bioprosthetic valves in young patients. There has also been a report of successful transcatheter neoaortic valve replacements in young patients after Fontan palliation. As an alternative to transcatheter valves, so called hybrid or sutureless rapid deployment aortic valves have recently been introduced into clinical practice. Although this concept is old, the current generation of these prostheses has been redesigned based on modern experiences with transcatheter valves. Current outcomes demonstrate that aortic valve replacement with sutureless valves could be a promising option for aortic stenosis, by facilitating minimally invasive surgery and minimizing cardiopulmonary bypass and cross clamping time. Therefore, the sutureless valve could prove to be an important alternative to conventional bioprosthetic aortic valve replacement in children too. In the current review, we provide an overview of the different types of transcatheter and sutureless aortic valve substitutes, discuss their advantages and short comings, and outline their clinical performance and potential benefits in a young patient population.

Clinical course and treatment of ectopic atrial tachycardia in 144 children

Ectopic atrial tachycardia (EAT) is a common type of supraventricular tachycardia in pediatric population, and it can be resistant to antiarrhythmic drugs and lead to tachycardia induced cardiomyopathy (TIC) if not properly managed. This study assessed the clinical course and response to treatment of EAT in children. A retrospective review included 144 children at the First Hospital of Tsinghua University diagnosed with EAT from January 2009 to April 2014. The clinical detailed history, 12 lead ECG, 24-h Holter recording, echocardiography, response to therapy and follow-up were analyzed. The onset of EAT occurred at any age with a distribution with positive skewness, 57 children ≤1 years, 22 children > 1 - 3 years, 25 children > 3 - 6 years and 40 children ≥ 6 years of age. The percentages of the three tachycardia types were 36. 1% (n = 52) for incessant EAT, 52. 8% (n = 76) for paroxysmal EAT and 11. 1% (n = 16) for sporadic EAT, respectively. There were 115 patients received drug therapy in our hospital and in 72 cases the EAT was completely controlled. Antiarrhythmic therapy had been discontinued in 35 children with complete control. Normal sinus rhythm was observed by telemetry or Holter within 4 to 90 days and the mean duration of medical therapy was 310 days (range 15 to 608 days) in these children. The combination of sotalol and propafenone showed better effectiveness for control of children with EAT (54%, 41/76), compared with single sotalol (36%, 24/66) and the combination of amiodarone and metoprolol (30%, 7/23) (χ2 = 6. 296, P = 0. 043). Tachycardia type was able to predict the response to antiarrhythmic drugs for children with EAT, sporadic tachycardia had best control rate on pharmacological therapy compared with paroxysmal tachycardia and incessant tachycardia (94% (15/16) vs. 67% (42/63) vs. 42% (15/36), χ2 = 17. 925, P = 0. 000) . Acute success of radiofrequency ablation (RFA) in children who showed poor response to antiarrhythmic drugs was achieved in 45 of 49 (92%), ultimate success was achieved in 33 of 49 (67%). The incidence of TIC secondary to EAT was 18. 1% (n =26), and left ventricular ejection-fraction (LVEF) returned to normal in 23 children after successful control of EAT ((61 ± 4) % vs. (43 ± 5) %, t = - 10. 036, P = 0. 000). Side effects including abnormal thyroid function (in 3) and abnormal liver function (in 1) occurred in 4 (17%) of 23 children who received amiodarone and disappeared when amiodarone was discontinued. EAT in children predominantly occurred in young infants and children. Incessant EAT comprised a great percentage. The combination of sotalol and propafenone provided the best results for control of children with EAT. RFA should be considered as a preferred treatment for older children who displayed poor response to medical therapy.

Effect of T plate in the treatment of older children with Salter-Harris II type of radial neck fracture

Objective To analyze the influence of radial neck fracture on the upper limb function in older children, and to evaluate the curative effect of plate fixation in the treatment of Salter-Harris II type of radial neck fracture. Methods The clinical data of 16 older children with radial neck fractures who treated by T plate internal fixation were retrospectively analyzed. 16 cases were closed fractures, merging radial nerve injury in 1 case,3 cases of distal humerus fractures,1 case with rib fractures, fractures were Salter- Harris II type,adopt steel plate internal fixa tion. Results 16 patients were followed up for 9-18 months. X-ray healing time was 6- 9 weeks on average 7.6 weeks. No malunion and no healing, no case of epiphyseal injuries. 1 patient appeared steel block forearm supination. Postoperative patients with forearm pronation were greater than 90°supination were greater than 60°. No radial nerve injury. Evaluation results were good. Conclusion Clinical treatment effect of open reduction and plate internal fixation in the treatment of older children with Salter- Harris II type of radial neck fracture is satisfactory. Surgical treatment not only can enhance the fracture stability, but also can do the elbow joint function exercise to prevent dysfunction much earlier. Key words: Radial neck fracture; T steel plate; Fracture fixation

Transcatheter neoaortic valve replacement utilizing the melody valve in hypoplastic left heart syndrome

Percutaneous transcatheter pulmonary valve replacement with the Melody Valve is fast becoming an important adjunct in the treatment of older children and adults with failing right ventricular outflow tract conduits. Recently, the Melody Valve has also been successfully implanted in the tricuspid, mitral, and aortic positions, typically within a failing bioprosthetic valve. We present a patient who underwent Fontan palliation for hypoplastic left heart syndrome variant and subsequently developed severe neoaortic regurgitation, which was successfully treated with a transcatheter neoaortic valve replacement. To our knowledge, this is the first successful use of the Melody Valve in the neoaortic position in a patient with single-ventricle physiology. Successful relief of neoaortic valve regurgitation using replacement with a transcatheter valve may allow avoidance of additional surgery, increase functional longevity of single-ventricle palliation, and postpone the need for orthotopic heart transplantation.

Tolerance to COX-2 inhibitors in children with hypersensitivity to nonsteroidal anti-inflammatory drugs

Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) can affect children, with the mechanism proposed being inhibition of the cyclooxygenase enzyme-1 (COX-1). In these patients nonchemically related NSAIDs, including COX-2 inhibitors, can induce the reaction, hampering treatment of fever and inflammatory processes. To analyse retrospectively tolerance to etoricoxib, a selective COX-2 inhibitor, and to meloxicam, a preferential COX-2 inhibitor, in children with hypersensitivity to NSAIDs. Clinical records of children (aged 1-14 years) diagnosed with hypersensitivity reactions to NSAIDs from January 2006 to January 2013 were included. The diagnosis was confirmed by oral drug provocation test (DPT) with the culprit NSAIDs and acetylsalicylic acid (ASA). Tolerance to paracetamol, etoricoxib and meloxicam was also evaluated. The study included 41 children with a positive DPT with ASA and the culprit NSAID. DPT with paracetamol and etoricoxib was negative in all children, although two (4.9%) children developed a reaction after the administration of meloxicam. These data indicate that both etoricoxib and meloxicam are good alternatives for treatment in older children with hypersensitivity to NSAIDs.

Acetabulumverletzungen im Kleinkindes- und Kindesalter

In this article, the anatomical and morphological features of the acetabulum in infancy and childhood are presented. The pathology and treatment of older children and adolescents is deliberately not covered, because the fracture morphology and treatment of patients aged 13 to 15 years is based on the criteria of adult medicine. Especially in the younger child, the anatomical differences are of particular importance. The younger the child is, the more difficult the diagnosis. Therefore today, MRI examinations should be generous used, even if anesthesia is necessary. If the injured child is hemodynamic stable, anesthesia can be electively used for a more complex diagnosis. Acetabular fractures are particularly problematic in infancy because even with optimal treatment and perfect reduction growth disturbances can occur. These manifest as so-called secondary dysplasia. During treatment, care should be taken to ensure that a surgical team having experience with the infant and juvenile skeleton is available and that appropriate implants are available.