Emergency Medicine Resident versus Radiologist in Detecting the Ultrasonographic Signs of Acute Cholecystitis; a Diagnostic Accuracy Study

Introduction: Dependence of ultrasonography on the operator’s skill plays a major role in the differences between various studies in reporting its diagnostic accuracy. Therefore, the present study was done with the aim of comparing the ultrasonography findings performed by emergency medicine resident and radiologist in evaluation of acute cholecystitis. Methods: The present diagnostic accuracy study has been carried out on patients presenting to the emergency department with complaint of pain in the right upper quadrant of abdomen suspected with acute cholecystitis. All the patients underwent gallbladder ultrasonography by a trained emergency medicine resident and a radiologist and their findings were compared with surgical and pathology findings regarding gallstone and increased gallbladder wall thickness. Results: 51 patients with the mean age of 42.3±15.8 (17-81) years were analyzed (82.4% female). The overall agreement between emergency medicine resident and radiologist in ultrasonographic diagnosis of cholecystitis was 0.421 (95% CI: 0.118-0.724). Based on the pathology and surgical findings, acute cholecystitis was confirmed for all 51 (100%) patients. Meanwhile, based on the ultrasonographic report of radiologist and emergency medicine resident only 45 (88.2%) and 34 (66.7%) patients, respectively, were diagnosed with cholecystitis. Screening performance characteristics of ultrasonography by radiologist for detection of gallbladder stone (p = 0.010) and gallbladder wall thickness (p < 0.0001) were significantly better than emergency medicine resident. Conclusion: The screening performance characteristics of ultrasonography by radiologist in detection of gallstones and increased wall thickness of gallbladder were significantly better

The comparison of effectiveness, safety, and clinical outcome of one steppercutaneous abscess aspiration versus drainage by insertion of a drainage catheter in children with post-appendectomy abscess

Introduction: Although radiologic guided abscess drainage with a drainage catheter has been a successful method for treatment of appendicular abscess after surgery, single stage aspiration technique could also be used as a good option in children with intra-abdominal abscess. The aim of this study was to compare efficacy, safety and clinical outcome of percutaneous abscess drainage versus aspiration in pediatric patients with post-appendectomy abscess formation.Materials and Methods: This randomized control trial was conducted under the supervision of Mashhad University of medical sciences. Children were enrolled in the study with suspicion of post-appendectomy abscess formation. Patients were divided into two groups (drainage or aspiration) with simple sampling method. Demographic characteristics and clinical outcome were compared between the two groups. Data analysis was done using SPSS version 16.Results: Fifty children with post-appendectomy abscess were enrolled in this study. Their mean age was 10.4 ± 4.1 year (range from 5 to 19yrs). Drainage was successful in 88% of patients and the succeed rate in aspiration group was 96% and this difference was not significant statistically (p=0.609). Duration of hospital stay was longer in the drainage group in comparison with aspiration (2.8 ± 0.55 vs. 2.1 ± 0.47, p-value < 0.001).Conclusion: Efficacy, safety and other clinical outcomes of percutaneous abscess drainage and aspiration were the same in pediatric patients with smaller than 5 cm post-appendectomy abscess. Due to lower cost and parental satisfaction, aspiration would be a good choice in children with small post-appendectomy abscess

Papillary Carcinoma Thyroid in a Nine-year-old Child: A Case Report

Thyroid enlargement and nodules are very rare in children, but when they occur, the chance of malignancy among these nodules is very high. Thyroid carcinoma is rare in childhood, but in the last two decades, its incidence has increased two-fold. A painless nodule in the neck is the most common presentation of the disease. Dysphagia, hoarseness, cervical lymphadenopathy, weight loss, and fatigue are other presentations. Surgical resection is the primary therapy for thyroid cancer. Levothyroxine and Iodine-131 (I131) are usually used as adjunctive therapy. This article presents the case of a 9-year-old girl who referred to our center with the chief complaint of a neck mass. Her symptoms had begun 6 months earlier

Acute Lymphoblastic Leukemia Following Nasopharyngeal Carcinoma: Report of an Unusual Case

Introduction: Nasopharyngeal carcinoma (NPC) is a rare malignancy in children. Nasal obstruction, otitis media with effusion, pain in the ear, hearing problems, and unusual neck mass are among the signs and symptoms of this malignancy.   Case Report: We report the case of a 13-year-old girl with NPC who later developed acute lymphoblastic leukemia (ALL) through the course of her disease. To our knowledge, this is the first report of ALL following childhood nasopharyngeal carcinoma in the English-language literature.   Conclusion: Reports of secondary malignancies at the site of radiotherapy for NPC exist, but this is the first report of ALL following NPC

Comparison of the Voiding Cystourethrogram Results One and Three weeks after the First Urinary Tract Infection in 1-Month to 15-Year-Old Children

Introduction: To determine whether the timing of voiding cystoureterogram (VCUG) in the first or the third week after a diagnosis of urinary tract infection (UTI) is important in the diagnosis and severity of VUR.Materials and Methods: In this case-control study, 72 children between 1 month and 15 years old diagnosed with their first episode of UTI were investigated over one year. The study population was divided into 2 groups of 36, early (VCUG in the first week after UTI) and late (VCUG 3 weeks after UTI), and compared the severity and incidence of reflux in both groups.Results: The prevalence of VUR was 66.6%. Twenty-two cases in the first group (61%) and 26 cases in the second group (72.2%) presented with VUR. The peak age of the disease in both groups was 1-3 years with a female predominance. The most common germ detected was E-Coli and the most common presentations were fever (87.5%) and dysuria (26.3%).Conclusions: As VUR following UTI is very common in children and is one of the most important risk factors of early hypertension and chronic renal failure, early diagnosis by VCUG seems to be useful in all UTI patients before discharge. Keywords: Urinary Tract Infection; Vesico-Ureteral Reflux; VCUG; Child

The Diagnostic Value of Different Sonography Findings and Color Doppler Sonography in Detecting Biliary Atresia in Infants and Neonates

Background: Biliary atresia (BA) is one of the most common etiologies of cholestasis in infants and toddlers. The most important factor in case of patients’ prognosis is its early diagnosis. There are many diagnostic tools in this field, sonography seems to be the most appropriate and fastest tool in early detecting and differentiating BA from other causes of neonatal cholestasis. The aim of this study was to evaluate the diagnostic value of new ultrasound and Doppler ultrasound methods in BA in infants and toddlers.Methods: This cross-sectional study was performed during a one-year period on 35 infants and toddlers admitted to the gastrointestinal department of Akbar Children's Hospital with suspicion of cholestasis. These children underwent sonography by a radiologist to diagnose BA. All required information was extracted from the hospital records of these children and analyzed after entering the checklist. Data were analyzed using SPSS software version 26.Results: Totally, 35 patients including 18 boys (51.4%) and 17 girls (6.48%) with a mean age of 4/29±4/17 months were enrolled. According to the findings of the analysis, 21 patients (60%) had bile duct atresia and 14 patients (40%) had other diseases. Ultrasound sensitivity in the diagnosis of bile duct atresia was 90%, with an accuracy of 74%, specificity of 50% and positive and negative predictive value of 73% and 77%, respectively. The highest diagnostic value was related to the former hepatic capsular flow.Conclusion: Biliary atresia can be accurately diagnosed by ultrasonography. The high sensitivity and accuracy of ultrasound indicate the appropriateness of this method in diagnosing this diseas

Proposed TART-RADS Classification for Testicular Ultrasound: Our Experience and Literature Review

Background: Testicular adrenal rest tumors (TARTs) are an important complication in patients with Congenital Adrenal Hyperplasia (CAH). Ultrasonography is the diagnostic modality of choice. In this study we examined the possibility of sonographic classification of TARTs in the Reporting and Data Systems (RADS) imaging format.Methods: 35 male patients with the diagnosis of congenital adrenal hyperplasia due to 21 hydroxylase deficiency were evaluated.Results: 19 patients had one or more sonographic findings of TARTs. No significant relation was found between 17 Hydroxyprogesterone (17 OH p), ACTH and androstenedione levels in patients with and without TARTs. Five sonographic patterns for testicular lesions were found. The five-stage classification of sonographic findings of TARTs is matched with histological classifications.Conclusion: This classification system will allow clinicians to perform more accurate approaches. In general, TARTS should be considered in male patients with CAH. Sonography is a good imaging modality for the diagnosis of TARTs. TART-RADS imaging of lesions will allow clinicians to develop more accurate and appropriate approache

The Effects of Botulinum Toxin Type A on Reducing Sialorrhea in Children with Cerebral Palsy: A Self-Controlled Clinical Trial

Background: Cerebral palsy stands as the main cause of mobility disability in childhood, and the accompanying sialorrhea exacerbates health and psychological issues for both the child and the family. We aimed to assess the effect of botulinum toxin type A on reducing sialorrhea in children with cerebral palsy.Methods: This self-controlled clinical trial was executed among children afflicted with cerebral palsy. The Teacher Drooling Scale was used as the data collection tool. The intervention involved the administration of botulinum toxin A, with a dosage ranging from 30 to 50 units in each parotid gland, skillfully guided by a radiologist using ultrasound. Sialorrhea scores were compared before and after the injection.Results: Our study included 21 children with cerebral palsy and sialorrhea. After the two post-injection weeks, a noteworthy drop was observed in the sialorrhea score (4.10±0.831) compared to the pre-injection score (4.71±0.463). The sialorrhea score until the ninth month after injection (1.121±3.43) was still significantly lower than the score before injection.Conclusion: The injection of botulinum toxin A emerges as a potent medication, significantly curtailing the drooling among patients with cerebral palsy. This finding can be used to prevent aspiration pneumonia and reduce social and psychological complications in this population

Screening Characteristics of Bedside Ultrasonography in Confirming Endotracheal Tube Placement; a Diagnostic Accuracy Study

Introduction: Confirmation of proper endotracheal tube placement is one of the most important and lifesaving issues of tracheal intubation. The present study was aimed to evaluate the accuracy of tracheal ultrasonography by emergency residents in this regard.  Method: This was a prospective, cross sectional study for evaluating the diagnostic accuracy of ultrasonography in endotracheal tube placement confirmation compared to a combination of 4 clinical confirmation methods of chest and epigastric auscultation, direct laryngoscopy, aspiration of the tube, and pulse oximetry (as reference test).Results: 150 patients with the mean age of 58.52 ± 1.73 years were included (56.6% male). Sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio of tracheal ultrasonography in endotracheal tube confirmation were 96 (95% CI: 92-99), 88 (95% CI: 62-97), 98 (95% CI: 94-99), 78 (95% CI: 53-93), 64 (95% CI: 16-255), and 0.2 (95% CI: 0.1-0.6), respectively.Conclusion: The present study showed that tracheal ultrasonography by trained emergency medicine residents had excellent sensitivity (>90%) and good specificity (80-90) for confirming endotracheal tube placement. Therefore, it seems that ultrasonography is a proper screening tool in determining endotracheal tube placement

A Novel Experience in Treatment of Liver Hydatidosis in Pediatrics: A Clinical Trial Study

Background Hydatidosis is a conventional health public problem in most parts of the world. Safe treatment of patients with hydatidosis has been a topic of debate for a long time. Surgical treatment always was associated with high morbidity and mortality. Medical treatment is also controversial. In this study, alternative procedure named Percutaneous, Aspiration and hypertonic Saline Instillation (PAHSI) was applied to treat patients with hydatidosis. Materials and Methods In this single-blind clinical trial, thirty-eight patients, ranging in age between 6 months and 16 years, with 81 hepatic hydatid cysts underwent PAHSI treatment. The consecutive steps including sonographic guidance, aspiration of cyst content and injection of 15% saline hypertonic were carried out in this method. Patients with multiple cysts also were treated by this procedure. Results Participants were 18 boys (47.3%) and 20 girls (52.6%) with mean age of 8.08+ 3.92 years. Almost half of the patients had single cyst (52.63%). During 2- year follow- up, no recurrences were observed; therefore, re-hospitalization and possible complications reduced considerably. Furthermore, this method was applicable to cure multiple cysts. Conclusion In PAHSI strategy, it seems that the complications of surgery (laparotomy and anesthesia) decreased since no complications observed after procedure, and cosmetic results in future are much better due to avoidance of incision