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This case report describes nonconvulsive status epilepticus of complex partial type in a 12-year-old, otherwise healthy girl. The case illustrates the characteristic epileptic twilight state with prolonged bizarre behaviour, psychosis, confusion and normal mental state. It may be difficult to identify the condition in childhood, as changes in behaviour and cognition are often recognized later than in adults. Treatment recommendations and other possible diagnoses are discussed.

Nonconvulsive status epilepticus (NCSE) is defined by cognitive or behavioural changes for at least 30 minutes supplemented with evidence of seizures on electroencephalogram (EEG). NCSE constitutes 25% of all cases of status epilepticus (SE) and the highest incidence is seen among children below one year of age. The condition frequently occurs in patients with neurological injuries, specific epilepsy syndromes, learning disabilities and in the course of convulsive SE. Aggressive treatment is recommended for complex partial NCSE and in comatose patients and cautious treatment is recommended in absence and simple partial NCSE.

The number of insulin pump users registered in the Danish paediatric diabetes clinics shows an increase of approximately 500% from 2002 to 2006. The current evidence for improved insulin treatment by insulin pump therapy is mainly based on retrospective follow-up studies. Well-organised, longer and prospectively designed RCTs - especially focussing on possible differences in the resources used by health care professionals - are warranted to provide sufficient evidence for any improved benefits of insulin pump therapy in children and adolescents with diabetes.

Sydenham's Chorea (SC), a major manifestation of acute Rheumatic Fever (RF), is a nonsuppurative sequelae of group A streptococcal infection. RF is a significant public health problem in developing countries, and SC continues to afflict large numbers of children throughout the world. Although the incidence of RF is low in industrialized countries, SC does occur. We recently treated two children with SC. Both children showed the typical features of SC, which are choreatic movements, hypotonia and emotional lability. We describe the course of SC in the two children.

Sydenham's Chorea (SC), a major manifestation of acute Rheumatic Fever, is an important cause of acquired chorea in childhood. The disorder is characterized by chorea, muscular weakness and a number of neuropsychiatric symptoms. The diagnosis of SC is based on clinical observation. There have been no double-blind, randomized studies to evaluate the symptomatic treatment of SC.

We report two cases of neonates with secondary pseudohypoaldosteronism due to pyelonephritis and congenital urinary tract malformations. Both patients presented with failure to thrive, dehydration, severe hyponatraemia and metabolic acidosis. One of the patients also developed severe hyperkalaemia. Secondary pseudohypoaldosteronism may resemble congenital adrenal hyperplasia. Early diagnosis is essential since both conditions, when untreated, are fatal, and treatment of the two differs significantly. Differential diagnosis may be achieved by acute analysis of urine culture and renal ultrasonography.

Recipients of solid-organ transplants are, due to immunosuppressive treatment, disposed to opportunistic infections including tuberculosis. We report a rare case of acute intramedullary tuberculous abscess in a Danish male recipient of a liver transplant. The problems in diagnostics, medical and surgical treatment are discussed.

Wilsons disease is a rare autosomal recessive disorder of copper transportation, which is fatal if not treated. The disease often starts in adolescence, and most common symptoms are due to liver-and/or brain involvement. This paper deals with an adolescent with Wilsons disease. His clinical presentation was joint complaints for almost two years. The final diagnosis was made by mutation analysis. It is stressed that the clinician should consider Wilson's disease in cases of unexplained liver- and neurological involvement as well as cases of repetitive unexplained joint symptoms in the pubertal period.

The number of major amputations performed for vascular disease in Bispebjerbx Hospital, Copenhagen, has decreased from 122 to 29 per year during the period 1981 to 1994. In diabetic patients the frequency decreased from 25.5/100,000 to 5.5/100,000, i.e. a reduction of 78 percent, and in non diabetics it decreased from 42.2/100,000 to 14.6/100,000, i.e. a reduction of 65 percent. During the period vascular surgery has become a surgical specialty (1983), bypass to infra-popliteal arteries (from 1988) and graft surveillance by colour duplex scanning (from 1983) has become routine and in 1993 a diabetic foot center was established. Initial experience with a diabetic foot center in a vascular surgery unit is reported.

Hydrops foetalis is an uncommon condition, occurring in 1/1400-1/4000 of all pregnancies. The possible etiologies to the disease are numerous and up to now the prognosis has been very dull, with a mortality-rate of 40-90%. A successfully treated case story is presented. It is concluded, that it is essential from the very beginning to treat the child aggressively to restore normal respiratory and circulatory function. When this is performed the child will have a good chance of surviving and developing normally.

From 1798 to 1916 dentistry was placed under the medical profession as a special studied subject--dentists were so to say authorized quacks. Doctors in dental practice were inviolable, but there were great problems with unauthorized groups of technicians and barbers, who ilegally gave dental treatment and acquired official permission to the lucrative transaction: to make false teeth. The fight which was basically for economic reasons but had also a professional background. It was not until 1916 with the first dental law that dentists were given their own professional status, but the quarrels with the unauthorized technicians continued until 1979.

The first Danish case report of a thorn-induced arthritis is presented. The symptoms and histopathology are similar to those in the cases described in foreign literature. The clinical presentation is that of transient acute synovitis, followed by an asymptomatic period, and later by a period of persistent symptoms, often after the thorn injury was forgotten. Histopathology shows granulomatous synovitis. Synovectomy and removal of the plant thorn usually results in normal joint function. The diagnosis should be remembered in undiagnosed cases of monoarticular arthritis.

The course of delivery in 1,545 primiparae who were considered to be in the low-risk group at the commencement of labour as assessed by the previous directives issued by the Danish Ministry of Health (1976) were reviewed. 2/3 were delivered normally as episiotomy was not regarded as a complication. 1/3 had complicated deliveries. In 350, the contractions were abnormal and intervention was required. 1/3 of these were delivered instrumentally. Haemorrhage of more than 500 ml, intrauterine asphyxia and Apgar score less than or equal to 7 at 1 minute occurred frequently in this group. A total of 1,195 did not receive treatment to improve contractions and, in this group, instrumental delivery was undertaken in 10%. Following normal labour pains and spontaneous delivery, complications in the third stage were observed in 77 out of 1,075 patients, including haemorrhage of more than 500 ml in 38 patients. Six infants in this group had Apgar scores less than or equal to 7 at 5 minutes. In the group with abnormal contractions and/or instrumental delivery, haemorrhage of more than 500 ml, retention of the placenta and signs of perinatal asphyxia occurred, however, significantly more frequently. The authors consider that home deliveries in primiparae cannot be recommended. Primiparae should be advised to be delivered in hospital as it is not always possible to predict complications.

A total of 5,519 consecutive single deliveries at term were analysed for maternal and foetal factors associated with breech presentation (UK). The protocol in this department for breech deliveries which permits vaginal delivery of foetuses estimated to be between 2,400 and 3,800 g in cases where the pelvis was considered to be clinically normal, was also evaluated. Breech presentation was found in 173 cases. In 102 of these circumstances were present which permitted trial of vaginal delivery. Seventy-seven were delivered vaginally. An increased frequency of low Apgar scores (less than 8) after one minute was demonstrated among infants delivered vaginally in the breech presentation on comparison with infants delivered by Caesarean section, whereas low scoring after five minutes occurred with the same frequency. One infant died during delivery. Follow-up of infants delivered in breech presentation (mean period of observation two years) showed developmental disturbances in three of the vaginally delivered infants and in five of those delivered abdominally. Two of the infants delivered abdominally had severe cerebral paresis and psychomotor retardation without evidence of intrauterine or severe neonatal asphyxia. On comparison with the population delivered in cephalic presentation (HST), significantly increased frequencies of primiparity and light-for-dates infants were found in the breech presentations. Low Apgar score after one minute was significantly more frequent in breech presentations while low Apgar scoring after five minutes occurred with the same frequency. The perinatal mortality rates in breech and cephalic presentations were 17.3 and 4.7 per 1,000 respectively. Following correction for lethal malformations, the rates were 5.8 and 3.8 per 1,000, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Tuberous sclerosis (TS) is a congenital disease with hamarthromata, localized in particular to the central nervous system and skin. Other organs such as the heart, kidneys and eyes are, however, frequently involved. The disease is much more common than originally assumed. The most recent investigations show a prevalence of 1:9,704. TS is a dominant hereditary disease but with varying penetration. The frequency of mutation is probably less than previously assumed. The gene for TS is localized to the long arm of chromosome 9 (q34). Prenatal diagnosis is not yet possible. The symptoms and the course of condition depend upon the organ system involved, the age of the patient and of the varying penetration. All patients with TS must be examined with Wood's lamp, and be submitted to sonography of the kidneys, echocardiography, ophthalmic examination and computed tomography of the cerebrum. Treatment is purely symptomatic but surgical intervention may be considered. The present authors recommend that all patients with TS are submitted to the abovementioned examinations once annually with the exception of computed tomography of cerebrum which is undertaken if cerebral involvement is suspected.

The relationship between birthweight (BW) and gestational age (GA) in 14,276 Danish children with GA of 35 to 42 completed weeks was illustrated employing 10%, 50% and 90% percentile curves. The curves were sex-specific. The number of light for dates (LFD) children defined by means of the 10% percentile (BW below 10th percentile) was 1,351 compared to 848 children when using the curve currently employed. The latter curve was based upon foreign children and moreover was not sex-specific. It is concluded that sex-specific and updated curves representing the population studied are mandatory in the diagnosis of LFD-children.