The incidence and ossification of sesamoid bones in the hands and feet were studied in 922 radiographs (400 hands and 522 feet) in an Arab population from Bahrain, 5-83 years of age and consisting of 549 adults (393 men and 156 women) and 373 children (286 boys and 97 girls). All radiographs of the hand and foot in the adult population showed two sesamoid bones in the thumb metacarpophalangeal (MCP) joint and in the hallucal metatarsophalangeal (MTP) joint, respectively. Only 2.3% and 1.5% of hands showed sesamoids at the MCP joints of the middle and ring fingers respectively compared to a reported incidence of 7.1% for each digit in Caucasians. The incidence of sesamoids in the MTP joints of third and fourth toes (0.6% each) and inferior to the hallucal interphalangeal joint (3.1%) is probably the lowest reported so far in the literature. In the hands, ossification commenced first in the thumb sesamoids, at the age of 10 years in females and 11 years in males and was completed by the age of 13 and 14 years, respectively. In the feet, ossification began first in the hallucal sesamoids at the age of 8 years in females and 9 years in males and was completed by the age of 10 years in both sexes. The incidence and ossification of sesamoids in the hands and feet in the Arab population from Bahrain seem to differ considerably from reports in other populations. The clinical significance of our findings is discussed.
We present a child aged 2 years 3 months who suffered heat stroke after being accidentally locked in a car during summer. She was unconscious with hyperthermia on admission and later showed biochemical evidence of liver, cardiac and muscle injury and associated electrolyte imbalance. Her level of consciousness gradually improved, but she showed evidence of cortical blindness, which had improved on follow-up. MR imaging on the 5th day revealed bilateral hippocampal hyperintensities along with hyperintensities in the cerebellum and in the cerebral cortex. Previous case reports of imaging in heat stroke revealed involvement of the cerebellum, thalami, basal ganglia and scattered cerebral involvement. We report this unique finding of hippocampal hyperintensities due to heat stroke.
BACKGROUND: Vomiting is a common manifestation of acute gastroenteritis in children and adolescents. When untreated, it can be a hindrance to oral rehydration therapy, which is the cornerstone in the management of acute gastroenteritis. Evidence is needed concerning the safety and efficacy of antiemetic use for vomiting in acute gastroenteritis in children. OBJECTIVES: To assess the safety and effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents. SEARCH STRATEGY: We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register comprising references identified from comprehensive electronic database searches and hand searches of relevant journals and abstract books of conferences. The search was re-run and is up to date as on 20 July 2010. SELECTION CRITERIA: Randomized controlled trials comparing antiemetics with placebo or no treatment, in children and adolescents under the age of 18, for vomiting due to gastroenteritis. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. MAIN RESULTS: We included seven trials involving 1,020 participants. Mean time to cessation of vomiting in one study was 0.34 days less with dimenhydrinate suppository compared to placebo (P value = 0.036). Pooled data from three studies comparing oral ondansetron with placebo showed: a reduction in the immediate hospital admission rate (RR 0.40, NNT 17, 95% CI 10 to 100) but no difference between the hospitalization rates at 72 hours after discharge from the Emergency Department (ED); a reduction in IV rehydration rates both during the ED stay (RR 0.41, NNT 5, 95% CI 4 to 8), and in follow-up to 72 hours after discharge from the ED stay (worst-best scenario for ondansetron RR 0.57, NNT 6, 95% CI 4 to 13) and an increase in the proportion of patients with cessation of vomiting (RR 1.34, NNT 5, 95% CI 3 to 7). No significant difference was noted in the revisit rates or adverse events, although diarrhea was reported as a side effect in four of the five ondansetron studies. In one study the proportion of patients with cessation of vomiting in 24 hours was (58%) with IV ondansetron, (17%) placebo and (33%) in the metoclopramide group (P value = 0.039). AUTHORS' CONCLUSIONS: Oral ondansetron increased the proportion of patients who had ceased vomiting and reduced the number needing intravenous rehydration and immediate hospital admission. Intravenous ondansetron and metoclopramide reduced the number of episodes of vomiting and hospital admission, and dimenhydrinate as a suppository reduced the duration of vomiting.
Based on the presence of a facet for the hamate two types of lunate bone have been described in the wrist; type I is without a facet for the hamate while type II bears a facet on the medial surface for articulation with the proximal pole of the hamate. Compared to type I lunates, type II lunates have been shown to have different kinematics, are more prone to clinically relevant degenerative changes in the hamato-lunate joint and may cause ulnar-sided wrist pain. The incidence of type II lunates seems to vary in different populations. Postero-anterior (PA) view of plain radiographs of the hand was studied in Arab subjects from Bahrain (n=381; 307 males and 74 females) to determine the incidence of type I and type II lunates. The mean age of the subjects was 31.1 years, the range being 18-80 years. In the population studied, only 148 (38.8%) of the 381 wrists showed type II lunate; 121 (31.7%) were found in males and 27 (7.1%) in females. There was no significant difference in the mean age of subjects with type I or type II lunates (P=0.16). There was no correlation between side and gender with the presence or absence of a hamate facet on the lunate. The incidence of type II lunate was much lower than reports in the literature of populations from the Western world, which could be attributed to a genetic variation in the Arab population in Bahrain. These data indicate that osteoarthritis of the hamate or lunate is less likely to be a cause of ulnar-sided wrist pain in Bahraini Arabs.
Pleuropulmonary blastoma (PPB) is a rare aggressive malignant tumor of infancy and early childhood. The tumor arises in the lung and pleura and is regarded as a pulmonary dysontogenetic or embryonic neoplasm. Four types are defined in literature. Type I PPB is a rare, cystic lung neoplasm in infants characterized by subtle malignant changes and a good prognosis. Recurrences after type I PPB are usually advanced with a poor prognosis.We report this case to increase awareness about this entity so that the pediatricians, pediatric surgeons, radiologist, and pathologist recognize it early.
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