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Injuries in Children
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
A meticulous examination of the injured child’s head is required, looking specifically for evidence of bruising, wounds, lacerations, abrasions and boggy swellings, as well as areas of tenderness that may indicate underlying fractures. Any lacerations should be carefully examined (but not probed) in order to exclude a depressed fracture. Signs of basal skull fractures should be excluded by checking for periorbital bruising, haemotympanum, bruising over the mastoid process and cerebrospinal fluid and blood leakage from the nasopharynx and ears. In infants, the tension of the anterior fontanelle should be assessed. The fundi should be examined in all children with head injury, especially in the setting of NAI, and specific findings are pathognomonic in the shaken baby syndrome. If suspected, this examination must be performed by an ophthalmologist as bilateral retinal haemorrhages strongly suggest NAI. If the child is under 5 years old, the modified version of the GCS should be used. Assessment of cranial nerves, peripheral nerves, motor function, posture and pupils may be possible only by observation alone, especially in the very young. The examination of the child’s head circumference as a baseline measurement is important, especially in infants.
Abnormal Labour
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
The attitude of the fetal head refers to the degree of flexion or extension at the upper cervical spine. Different longitudinal diameters are presented to the pelvis depending on the fetal attitude. In a well-flexed head, the anterior fontanelle is not easily felt, and the presenting diameter is the suboccipito-bregmatic, which measures about 9.5 cm at term (Figure 8.5A). In OP and occipitotransverse (OT) positions, which are often associated with deflexion of the fetal head, the anterior fontanelle is felt at a lower plane and assumes a more medial position compared to the posterior fontanelle, and the presenting diameter is the occipito-frontal which measures about 10.5 cm at term (Figure 8.5B). The extension of the fetal head leads to brow and face presentations (Figures 8.5C and D).
Growth and development
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
1.42. The anterior fontanelleusually closes by 3 months of age.is rarely pulsatile.marks the junction of the sagittal and coronal sutures.may not bulge in the presence of meningitis.is usually smaller than the posterior fontanelle.
Intracranial sewing needle – accidentally inserted from a traditional cap worn by infants
Published in British Journal of Neurosurgery, 2023
Oliyath Ali, Ishrit Yasin, Mohd Abbas, Mohd Hussain
As far as the cause of the foreign body in our case is concerned, it is highly likely that the needle must have been accidentally inserted from the skull cap with sewing needles holding the decorations the patients was wearing during her infancy as per part of the tradition her tribe follows. The location of the foreign body in the frontal lobe near the location of bregma in infancy suggested its insertion during infancy through the open anterior fontanel. There was no injury or bleeding from the scalp which might have suggested its insertion during the minor head trauma. There have been reports of voluntary infanticide earlier in literature inserting sewing needles in the brain through the open fontanels during infancy. The offending person is usually the stepmother, but psychopathic mother, aunt, stepsister, and baby sitter have also been mentioned as offenders.11,15 If the first homicide attempt were not successful, a second, third, or even more attempts might be performed to harm the victim.10 In our case there was no such history of any child abuse or any other history relating to the insertion of foreign body in her brain.
Clinical, biochemical and molecular spectrum of mild 6-pyruvoyl-tetrahydropterin synthase deficiency and a case report
Published in Fetal and Pediatric Pathology, 2021
Boyan Song, Zhijun Ma, Wei Liu, Lihong Lu, Yongjian Jian, Lu Yu, Zhihui Wan, Xiaofei Yue, Yuanyuan Kong
The patient is a female infant, delivered vaginally after 40 weeks of pregnancy, with a birth weight of 3430 g and a body length of 51 cm. The neonatal screening showed that the patient’s blood phenylalanine level was 221.6 µmol/L (reference range: 30–117 µmol/L). At day 21 after birth, she was admitted to our hospital. The phenylalanine level in blood was 859.6 µmol/L. No manifestations, such as skin whitening and yellowing, poor appetite, sucking weakness, dysphagia, decreased responsiveness, weakness, somnolence or convulsions were detected. No specific odor was found in urine. Moreover, jaundice, rash, and bleeding spots were not observed on the skin. No unusual facies and no yellow hair were observed. The anterior fontanel was flat and soft, and the tension was not high. Because getting results of urine pterin spectrum analysis and dihydropteridine reductase (DHPR) analysis for further diagnosis need several days, a low phenylalanine diet was administered.
MicroRNA-185 activates PI3K/AKT signalling pathway to alleviate dopaminergic neuron damage via targeting IGF1 in Parkinson’s disease
Published in Journal of Drug Targeting, 2021
Xiaocui Qin, Xia Zhang, Pinyu Li, Min Wang, Li Yan, Peiling Pan, Hailing Zhang, Xuejun Hong, Muxi Liu, Zeqing Bao
Rats were anaesthetised with pentobarbital sodium (50 µg/kg, Chemical Reagents Shanghai Co., Ltd., Shanghai, China) and fixed in a prone position in a stereoscopic locator (RWD Life Science Co., Shenzhen, China). The skin on the head was sterilised with 75% ethanol and cut with a sharp knife to expose the skull. Started from the anterior fontanelle, two points of the medial forebrain bundle were drilled based on the Paxinos & Watson mode, one was located at 4.4 mm posterior to the anterior fontanelle, 1.2 mm to the right of the midline, and 7.8 mm below the skull, while the other one at 4.0 mm posterior to the anterior fontanelle, 0.8 mm to the right of the midline, and 8.0 mm below the inner skull. The injection doses of 6-OHDA (Sigma-Aldrich) were 2.25 µL and 2.7 µL, respectively, and rats were injected with 6-OHDA at 1 µL/min for 5 min. The rats were kept warm after the operation and raised in cages with sufficient food and water (20–25 °C, lighting time of 8.00am–8.00pm). Penicillin was used to prevent infection for 3 d at 200,000 U per day. In the same way, 2.25 µL and 2.7 µL of normal saline were injected into the medial forebrain bundle of rats as a sham control [21].