53 research outputs found
A case of split notochord syndrome: a child with a neuroenteric fistula presenting with meningitis
The authors describe a case of split notochord syndrome with a neuroenteric fistula in a newborn presenting with meningitis. Associated anomalies included agenesis of the corpus callosum, short colon, malrotation, epispadias, and an abnormally high bifurcation of the abdominal aorta and inferior vena cava. The embryological mechanisms and etiologic theories are discussed in short
Spinal epidural abscess presenting with abdominal pain
We report a case of spinal epidural abscess presenting as abdominal pain. An 7-year-old boy presented with abdominal pain. He was operated on under suspicion of appendicitis. During operation, no abnormalities were found. Postoperatively, the abdominal pain did not subside. Subsequently, the boy developed neurological abnormalities. MR1 showed a spinal epidural abscess. A laminectomy was performed and the boy was treated with antibiotics; he recovered well. This case showed that it is important to consider a spinal epidural abscess as a cause of abdominal pain with fever in children
Anterior joint capsule of the normal hip and in children with transient synovitis: US study with anatomic and histologic correlation
PURPOSE: To study the anatomic components of the anterior joint capsule of
the normal hip and in children with transient synovitis. MATERIALS AND
METHODS: Six cadaveric specimens were imaged with ultrasonography (US)
with special attention to the anterior joint capsule. Subsequently, two
specimens were analyzed histologically. These anatomic findings were
correlated with the US findings in 58 healthy children and 105 children
with unilateral transient synovitis. RESULTS: The anterior joint capsule
comprises an anterior and posterior layer, mainly composed of fibrous
tissue, lined by only a minute synovial membrane. Both fibrous layers were
identified separately at US in 98 of 116 (84%) hips of healthy subjects
and in all hips with transient synovitis. Overall, the anterior layer was
thicker than the posterior layer. In transient synovitis compared with
normal hips, no significant thickening of both layers was present (P = .24
and .57 for the anterior and posterior layers, respectively). Normal
variants include plicae, local thickening of the capsule, and
pseudodiverticula. CONCLUSION: Increased thickness of the anterior joint
capsule in transient synovitis is caused entirely by effusion. There is no
US evidence for additional capsule swelling or synovial hypertrophy
Body composition of patients with neuroblastoma using computed tomography
Background Computed tomography (CT) is often used to investigate muscle and fat mass in adult patients with cancer. However, this method has rarely been used in the pediatric cancer population. The present retrospective study aimed to investigate changes in body composition using CT during treatment in children with neuroblastoma. Procedure CT images of 29 patients with high-risk neuroblastoma were retrospectively analyzed at diagnosis and longitudinally during treatment. The cross-sectional area of skeletal muscle, intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) and skeletal muscle density at the level of the third lumbar vertebra were examined. To correct for height, cross-sectional areas were divided by height in meters squared. A linear mixed model was estimated to investigate changes in body composition over time. Results A small increase in skeletal muscle (p = .029), skeletal muscle density (p = .002), and IMAT (p < .001) was found. Furthermore, a rapid increase in VAT (p < .001) and SAT (p = .001) was seen early during treatment with the highest volumes after six cycles of chemotherapy. Conclusions CT scans obtained during standard care provide insight into the direction and timing of changes in skeletal muscle and different types of adipose tissue in childhood cancer patients. Future research is needed regarding the consequences of the rapid increase of VAT and SAT early during treatment.Development and application of statistical models for medical scientific researc
Mammographic and sonographic spectrum of non-puerperal mastitis
The goal of this study was to explore possible specific mammographic and sonographic features in women with non-puerperal mastitis (NPM), in order to make an accurate diagnosis and prevent unnecessary surgical procedures. From a group of 93 patients with NPM diagnosed between 1987 and 1992, the mammograms of 41, the sonograms and cytology of 47, and the histology of seven patients were retrospectively reviewed. Follow-up was performed on those without histology. In 20 of the 47 patients the inflammation was located subareolarly. In 50% of those with non-subareolar lesions, mammography showed a circumscribed lesion. Sonographically, all patients had an identifiable lesion either well or poorly defined. The majority of the lesions were cystic, but in 23 of 47 cases solid components were seen. Signs of infection in cystic lesions were observed in 25 of 47 cases. Posterior shadowing was not observed. During the follow-up period no breast malignancy was found. It is concluded that NPM has no specific mammographic or sonographic sign. Diagnosis should be made with additional diagnostic assessment, such as FNAB, which was diagnostic in all cases
Progressive damage on high resolution computed tomography despite stable lung function in cystic fibrosis
For effective clinical management of cystic fibrosis (CF) lung disease it
is important to closely monitor the start and progression of lung damage.
The aim of this study was to investigate the ability of high-resolution
computed tomography (HRCT) scoring systems and pulmonary function tests
(PFT) to detect changes in lung disease. CF children (n=48) had two H
Estimation of lung growth using computed tomography
Anatomical studies suggest that normal lungs grow by rapid alveolar
addition until about 2 yrs of age followed by a gradual increase in
alveolar dimensions. The aim of this study was to examine the hypothesis
that normal lung growth can be monitored by computed tomography (CT).
Therefore, the gas volume per gram of lung tissue was estimated from
measurements of lung density obtained from CT scans performed on children
throughout the growth period. CT scans were performed on 17 males and 18
females, ranging in age from 15 days-17.6 yrs. CT-measured lung weight was
correlated with predicted post mortem values and CT measured gas volume
with predicted values of functional residual capacity. The median value
for lung expansion was 1.86 mL x g(-1) at 15 days, decreased to 0.79 mL x
g(-1) by 2 yrs and then increased steadily to 5.07 mL x g(-1) at 17 yrs.
Computed tomography scans can be used to estimate lung weight, gas volume
and expansion of normal lungs during the growth period. The increase in
the lung expansion after the age of 2 yrs suggests progressive alveolar
expansion with increasing lung volume
Changes in globus pallidus with (pre)term kernicterus
OBJECTIVE: We report serial magnetic resonance (MR) and sonographic
behavior of globus pallidus in 5 preterm and 3 term infants with
kernicterus and describe the clinical context in very low birth weight
preterm infants. On the basis of this information, we suggest means of
diagnosis and prevention. METHODS: Charts and MR and ultrasound images of
5 preterm infants and 3 term infants with suspected bilirubin-associated
brain damage were reviewed. Included were preterm infants with severe
hearing loss, quadriplegic hypertonia, and abnormal hypersignal of globus
pallidus on T2-weighted MR imaging (MRI). In 1 infant who died on day 150,
the diagnosis was confirmed during the neonatal period. The others were
picked up as outpatients and scanned at 12 or 22 months' corrected age.
Three instances of term kernicterus were included for comparison of serial
MRI in the neonatal period and early infancy: they were caused by
glucose-6-phosphate dehydrogenase deficiency, urosepsis, and dehydration
plus fructose 1-6 biphosphatase deficiency. RESULTS: Five preterm infants
of 25 to 29 weeks' gestational age presented with total serum bilirubin
(TSB) levels below exchange transfusion thresholds commonly advised. Mixed
acidosis was present in 3 infants around the TSB peak. The
bilirubin/albumin molar ratio was >0.5 in all, in the absence of
displacing drugs. All failed to pass bedside hearing screen tests and had
severe hearing loss on auditory brain response testing. Symmetrical
homogeneous hyperechogenicity of globus pallidus was the alerting feature
in 1 infant. Globus pallidus was hyperintense on T1-weighted MR images in
this child. The other infants presented with severe developmental delay as
a result of dyskinetic quadriplegia and hearing loss. Globus pallidus was
normal on T1- but hyperintense on T2-weighted MR images at 12
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