Multiple injuries in children are responsible for a great part of childhood mortality. Remaining handicaps after injuries have a social and economic significance. In this study, the characteristics of polytrauma in childhood are evaluated by comparison with severely injured adults. The two groups of multiple trauma patients (117 children between 3 and 15 years of age and 1159 adults between 16 and 59) were equal in the overall severity of all injuries. Children were mainly hurt as pedestrians, whereas adults had an accident more often as car passengers. The most frequently injured region were in both groups fractures of the extremities. The greatest injury severity represented head injuries in each group. Complications were seen more often in adult patients. Multiple organ failure and isolated liver failure were exclusively seen in the adult group, pneumonia and lung failure occurred significantly more often. The duration of artificial ventilation and the duration of hospital stay were prolonged in the adult group. In summary, children with multiple injuries have a lower mortality rate than adults. The main cause of death are cerebral injuries. Remaining handicaps in surviving children are most often caused by fractures of the lower extremities.
Early operation should be adopted as a standard option in thyroid storm that cannot be controlled medically. Best results are achieved if the operation is done at stage one or two of the disease.
Reasons for postoperative persistence of primary hyperparathyroidism (pHPT) are missed parathyroid adenoma, incomplete removal of multiple altered pararthyroid glands, and rare variants of localisation. A reoperation is indicated in symptomatic patients if calcium serum levels are elevated above 2.9 mmol/l. Preoperatively, cervical sonography and 99mTc sestamibi scintigraphy should be carried out. Additionally, selective venous blood sampling and nuclear magnetic resonance tomography can be of use. After successful localization, a unilateral approach is advisable. If position remains unclear, bilateral exploration is required. In secondary hyperparathyroidism (sHPT), renal function is crucial for development of recurrence. For postoperative persistence, identification of less than four pararthyroid glands or leaving of the thymus are the main reasons. Before reoperation it has to be clarified if parathyroid hyperfunction is caused by persisting cervical or mediastinal tissue, or if hyperfunction of autotransplanted tissue in the forearm is evident. Diagnostic and operative procedures are similar to those used in pHPT.
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