Acute lobar nephritis in children: Not so easy to recognize and manage

Acute lobar nephritis (ALN) is a localized non-liquefactive inflammatory renal bacterial infection, which typically involves one or more lobes. ALN is considered to be a midpoint in the spectrum of upper urinary tract infection, a spectrum ranging from uncomplicated pyelonephritis to intrarenal abscess. This condition may be difficult to recognize due to the lack of specific symptoms and laboratory findings. Therefore the disease is probably underdiagnosed. Computed tomography scanning represents the diagnostic gold standard for ALN, but magnetic resonance imagine could be considered in order to limit irradiation. The diagnosis is relevant since initial intravenous antibiotic therapy and overall length of treatment should not be shorter than 3 wk. We review the literature and analyze the ALN clinical presentation starting from four cases with the aim to give to the clinicians the elements to suspect and recognize the ALN in children

Adolescent Athlete With Sudden Groin Pain

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L'ecografia nella diagnostica delle fratture: Una revisione della letteratura, la nostra esperienza, la possibile applicazione

In the emergency room the current management of the patient with suspected fracture involves a physical examination of the damaged area, an examination by the specialist and the performance of radiographic projections depending on the clinical suspicion. Analyzing the literature, there is evidence that the ultrasound method can be useful to perform an assessment of the first instance. In fact, the ultrasound diagnosis of fractures is now a method that, if performed by trained staff (also in a short time), has a good specificity and sensitivity. So, it could be performed as a first approach to trauma with suspected fracture, before the specialist examination. The paper highlights that ultrasound, performed by the radiologist, or by a paediatrician after a short specific training, presents good sensitivity and specificity in the diagnosis of fractures of the hands and fingers

Diagnostic accuracy of ultrasonography for hand bony fractures in paediatric patients

OBJECTIVE: Hand fractures are common in childhood, and radiography is the standard diagnostic procedure. US has been used to evaluate bone injuries, mainly in adults for long-bone trauma; there are only a few studies about hand fractures in children. The purpose of this study was to evaluate and confirm the safety and applicability of the US diagnostic procedure in comparison to X-ray diagnosis. STUDY DESIGN: This cross-sectional study involved a convenience sample of young patients (between 2 and 17\u2005years old) who were taken to the emergency department due to hand trauma. After clinical assessment, patients with a suspected hand fracture first underwent X-ray, and subsequently US examination by two different operators; a radiologist experienced in US and a trained emergency physician in "double-blind" fashion. US and radiographic findings were then compared, and sensitivity as well as specificity was calculated. RESULTS: A total of 204 patients were enrolled in the study. Seventy-nine fractures of phalanges or metacarpals were detected by standard radiography. When US imaging was performed by an expert radiologist, 72 fractures were detected with sensitivity and a specificity of 91.1% and 97.6%, respectively. Sensitivity and specificity were found to be (respectively) 91.5% and 96.8% when US was performed by the ED physicians. CONCLUSIONS: US imaging showed excellent sensitivity and specificity results in the diagnosis of hand fractures in children. The study also showed a great agreement between the results of the US carried out by the senior radiologist and those carried out by the paediatric emergency physician, suggesting that US can be performed by an ED physician, allowing a rapid and accurate evaluation in ED and could become the first diagnostic approach whenever a hand fracture is suspected

Dolore da venipuntura: come trattarlo?

Venipuncture, although it is relatively simple and fast, is one of the painful procedures which is most frequently performed on paediatric patients. The pain in this context is present in 50% of children, and has been rated as moderate to severe in 36% of children aged 3 to 6 years and 13% of those aged 7 to 17 years. The response to pain is influenced and shaped by past painful experiences. Infants who have not been adequately treated in regard to procedural analgesia undergo a real conditioning. Considering that pain has two basic components, nociception and suffering, the best approach will be multidisciplinary, based on pharmacological and non-pharmacological strategies