Purpose: To report a case of isolated medial orbital wall fracture with enophthalmos in a paediatric patient and describe the clinical presentation and findings by means of computed tomography (CT) of the head and eyes. Methods: We looked at the patient’s medical and ophthalmologic history, and an ophthalmologic examination and a CT of the head were performed at baseline. Results: A 14-year-old boy was admitted to the emergency department of our institution with ecchymosis of his right eyelids secondary to a sport accident. Physical examination revealed a moderate limitation of upgaze without diplopia. CT showed a medial orbital wall fracture without haemorrhage and a gross accumulation of air in the right eyelid with pressure exertion over the right globe and enophthalmos. The patient was treated conservatively with oral antibiotics and steroids showing dramatic improvement within 1 week. Enophthalmos and periorbital emphysema were completely resolved within 3 months after the accident as indicated by CT. Conclusions: We conclude that surgical intervention and intravenous treatment are not warranted in similar cases of medial orbital wall fracture. Medical history, clinical and paraclinical evaluations, and a regular follow-up, including CT, are needed though to avoid complications such as painful abduction, horizontal diplopia, pseudo sixth nerve paresis, or pseudo Duane.

Objective: To identify predictors of early readmission in children with asthma. Design/Methods: A case-control study of a cohort of children hospitalized for asthma. Cases were children with asthma readmitted with the same diagnosis within 30 days of the index admission. For each case, we identified up to two controls which were children hospitalized for asthma but not readmitted within 30 days.Cases and controls were matched for age, gender, ethnicity, season and year of index admission. Data were abstracted from the medical records. Bivariate analyses (clogit, GEE statistics) were performed. Conditional logistic regression analysis determined the relative contribution of independent variables.Results: 458 subjects were analyzed (161 cases, 297 matched controls). Cases and controls were successfully matched (mean age for cases 6.4 years (SD 5.3) vs 6.4 years (SD 5.1) for controls; for both groups 64% were male, 61% Hispanic and 36% African American). Cases had a greater mean number of lifetime admissions for asthma (8.2 vs 3.3, pϽ.0001), were more likely to have received a pulmonary consultation prior to the index admission (OR 2.49, 95% CI 1. 45-4.29) and to have a history of asthma ICU admission (OR 2.20, 95% CI 1.31-3.70). Using conditional logistic regression, history of multiple lifetime admissions was found to be an independent predictor of readmission. Exposure to environmental triggers was not associated with readmission. No significant difference was found between the groups on mean oxygen saturation at index admission or discharge, need for oxygen supplementation during the index admission, and presence of wheezing at discharge.Conclusions: Our findings suggest that early readmission occurs among a subset of children with greater disease severity. History of multiple admissions, receipt of pulmonary consultation and prior ICU admission may identify children who are more likely to be readmitted and thus, guide inpatient and outpatient asthma management. PRENATAL EXPOSURE TO DEXAMETHASONE PERMANENTLY ALTERS THE EXPRESSION OF 11BETA HSD1, MINERALCORTICOID AND 5HT1B RECEPTOR IN RAT HIPPOCAMPUSKC PAGE 1 1 BUCKNELL UNIVERSITY (USA) Changes in gene expression in the brain, pituitary, and adrenal have been reported in a number of prenatal stress studies. However, it is not clear whether the high maternal glucocorticoid (GC) level is directly responsible for these perturbations. We exposed rat dams to DEX during gestation days 14 -19 and found a significant decrease in birth weight and adult weight of the male offspring. In addition, this treatment elicited a significant increase in serum ACTH and CORT. In contrast, circulating levels of serotonin were significantly lower in the DEX-exposed adult males. Using real time RT-PCR we measured a significant decrease in the hippocampal mineralcorticoid receptor (MR) and serotonin receptor, 5-HT1B. In contrast, the mRNA levels measured for hippocampal 5-HT1A, 5-HT2A, and glucocorticoid receptor (GR) were not significantly different from the control animals. Interesti...

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