| Bell's
palsy is an acute idiopathic paralysis of the VII cranial nerve (facial
nerve) resulting in inability to control facial muscles on the affected
side. Bell's palsy is a non life-threatening disorder that can
cause significant impact in the life of the child. Other conditions
that can cause fascial paralysis include brain tumor, head trauma,
meningitis and Lyme's disease. The mean age of involvement is eight
years with a similar sex predilection. It is thought that an
inflammatory condition leads to swelling of the facial nerve and
compression in the narrow bone canal leading to nerve inhibition,
damage or death. No readily identifiable cause for Bell's palsy has
been found, though acute immune demyelination triggered by a viral
infection may be responsible. The school nurse may be the first person
to assess facial palsy and muscle weakness in children. Careful
diagnosis and workup using head CT and MRI is warrant in all cases to
exclude other serious causes of fascial paralysis. MRI enhancement of
the distal intrameatal and labyrinthine segments of the nerve canal are
specific for facial nerve palsy. Complete spontaneous recovery is seen
in almost 70% of patients within six weeks of onset, but up to 30% have
delayed or incomplete recovery. Use of steroid or antiviral therapy is
controversial since most children recover without treatment.
Physiotherapy, in the form of transcutaneous peripheral nerve
stimulation, has an important role. References: 1- Kinoshita T, Ishii K, Okitsu T, Okudera T, Ogawa T: Facial nerve palsy: evaluation by contrast-enhanced MR imaging. Clin Radiol. 56(11):926-32, 2001 2- Dhiravibulya K: Outcome of Bell's palsy in children. J Med Assoc Thai. 85(3):334-9, 2002 3- Singhi P, Jain V: Bell's palsy in children. Semin Pediatr Neurol. 10(4):289-97, 2003 4- Atzema C, Goldman RD: Should we use steroids to treat children with Bell's palsy? Can Fam Physician. 52:313-4, 2006 5-Shih WH, Tseng FY, Yeh TH, Hsu CJ, Chen YS: Outcomes of facial palsy in children.Acta Otolaryngol. 15:1-6, 2008 6- Gordon SC: Bell's palsy in children: role of the school nurse in early recognition and referral. J Sch Nurs. 24(6):398-406, 2008 |
| Shoulder
dislocation in infants most commonly occurs in the newborn period,
directly after delivery. Breech presentation, macrosomia, prolonged
labor and assisted birth are risk factors associated with shoulder
dystocia. Shoulder dystocia associated with brachial plexus palsy
occurs in approximately 1.5% of all births. Associated with brachial
plexus palsy, posterior shoulder dislocation and subluxation can
develop directly after birth or even one year later due to the
glenohumeral deformity that results from the persistence muscle
imbalance. Mean age at time of diagnosis is six months. Diagnosis of
shoulder dislocation is based in physical examination, radiographs,
ultrasound and MRI. Specific clinical signs include asymmetry of skin
folds of the axilla or the proximal aspect of the arm, apparent
shortening of the humeral segment, a palpable asymmetric fullness in
the posterior region of the shoulder, or a palpable click during
shoulder manipulation. All children with a brachial plexus birth lesion
should be screened, above the assessment of neurological recovery,
during the first year of life for posterior shoulder dislocation since
such a condition may occur in 7% of children with a brachial
plexus birth lesion. Management consists of prompt closed reduction of
the shoulder by traction combined with adduction of the upper arm and
countertraction with a gauze encircling the chest. The functional
outcome is related to the severity of the neurological lesion, the
duration of the dislocation and onset of deformity. References: 1- Dodds SD, Wolfe SW: Perinatal brachial plexus palsy. Curr Opin Pediatr. 2000 Feb;12(1):40-7. 2- Moukoko D, Ezaki M, Wilkes D, Carter P: Posterior shoulder dislocation in infants with neonatal brachial plexus palsy. J Bone Joint Surg Am. 2004 Apr;86-A(4):787-93 3- Kambhampati SB, Birch R, Cobiella C, Chen L: Posterior subluxation and dislocation of the shoulder in obstetric brachial plexus palsy. J Bone Joint Surg Br. 2006 Feb;88(2):213-9 4- Dahlin LB, Erichs K, Andersson C, Thornqvist C, Backman C, Düppe H, Lindqvist P, Forslund M: Incidence of early posterior shoulder dislocation in brachial plexus birth palsy. J Brachial Plex Peripher Nerve Inj. 2007 Dec 16;2:24. 5- Wessels R, Sleeboom C, de Vries JI, van Elburg RM: Shoulder dislocation in a very-low-birth-weight infant: case report and review of the literature. J Pediatr Surg. 2009 Dec;44(12):e19-20 |
| Yolk
sac tumor, also known as endodermal sinus tumor, is a common phenotype
of testicular malignancy arising in descended testes. This tumor does
not arise from the yolk sac, as the name implies, but from the germinal
epithelium of the testis which has the ability to mimic the
development pattern found in the yolk sac. Painless unilateral
testicular enlargement is the most common presenting symptom in
children. An associated hydrocele can delay the correct diagnosis.
Ultrasound and CT scan will help suggest the diagnosis and extension of
tumor. The definitive diagnostic step is surgical exposure of the
testis through an inguinal incision, vascular exclusion and high cord
ligation removal for histologic examination. Microscopy reveals an
intermingle of epithelial and mesenchymal elements in a characteristic
embryoid organoid pattern. Yolk sac tumor secretes alpha feto-protein,
a marker helpful in the follow-up of these patients. The tumor spreads
to lymph nodes and hematogenous (lung). After surgery the need of
chemotherapy, radiotherapy or retroperitoneal lymph node dissection
will depend on the presence of residual micro- or macroscopic disease.
Patients with localized disease and normal postoperative serum
alpha-fetoprotein levels do not benefit from retroperitoneal node
dissection, postoperative abdominal irradiation or chemotherapy.
Patients with retroperitoneal nodal involvement, widely metastatic
disease or recurrent disease can be treated successfully with
chemotherapy and in some cases with radiation therapy. For the few who
do relapse, treatment at the time of relapse is curative for the
majority. References: 1- Olsen MM, Raffensperger JG, Gonzalez-Crussi F, Luck SR, Kaplan WE, Morgan ER: Endodermal sinus tumor: a clinical and pathological correlation. J Pediatr Surg. 17(6):832-40, 1982 2- Flamant F, Nihoul-Fekete C, Patte C, Lemerle J: Optimal treatment of clinical stage I yolk sac tumor of the testis in children. J Pediatr Surg. 21(2):108-11, 1986 3- Griffin GC, Raney RB Jr, Snyder HM, Duckett J, D'Angio GJ: Yolk sac carcinoma of the testis in children. J Urol. 137(5):954-7, 1987 4- Shah JP, Kumar S, Bryant CS, Ali-Fehmi R, Malone JM Jr, Deppe G, Morris RT: A population-based analysis of 788 cases of yolk sac tumors: A comparison of males and females. Int J Cancer. 123(11):2671-5, 2008 5- De Backer A, Madern GC, Wolffenbuttel KP, Oosterhuis JW, Hakvoort-Cammel FG, Hazebroek FW: Testicular germ cell tumors in children: management and outcome in a series of 20 patients. J Pediatr Urol. 2(3):197-201, 2006 6- Steffens J, Treiyer A, Calaminus G: Management of pediatric testicular tumors : diagnosis, therapy, and follow-up. Urologe A. 48(4):359-63, 2009 |
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