Infected epidermal cyst of the clitoris in an infant

Clitoral enlargement in the pediatric population is a rare condition, usually related to problems of sexual differentiation, but malignant and benign clitoral lesions have also been described. We report the case of a newborn infant, investigated at birth for an intersex disorder because of clitoromegaly. Hormonal screening was normal and ultrasound (US) did not show a pelvic or abdominal mass. Three weeks later, the lesion was larger, tense and erythematous. An abscess was suspected. A drainage was then performed, and the bacteriological culture revealed the presence of Staphylococci aurei. A magnetic resonance imaging (MRI) performed to exclude a tumor of the soft tissue was normal. A diagnosis of infected epidermal cyst was confirmed by the pathology. Two months later, the external genital aspect was normal and the child asymptomatic

Use of an Online Ultrasound Simulator to Teach Basic Psychomotor Skills to Medical Students During the Initial COVID-19 Lockdown: Quality Control Study.

Teaching medical ultrasound has increased in popularity in medical schools with hands-on workshops as an essential part of teaching. However, the lockdown due to COVID-19 kept medical schools from conducting these workshops. The aim of this paper is to describe an alternative method used by our medical school to allow our students to acquire the essential psychomotor skills to produce ultrasound images. Our students took online ultrasound courses. Consequently, they had to practice ultrasound exercises on a virtual simulator, using the mouse of their computer to control a simulated transducer. Our team measured the precision reached at the completion of simulation exercises. Before and after completion of the courses and simulator's exercises, students had to complete a questionnaire dedicated to psychomotor skills. A general evaluation questionnaire was also submitted. A total of 193 students returned the precourse questionnaire. A total of 184 performed all the simulator exercises and 181 answered the postcourse questionnaire. Of the 180 general evaluation questionnaires that were sent out, 136 (76%) were returned. The average precourse score was 4.23 (SD 2.14). After exercising, the average postcourse score was 6.36 (SD 1.82), with a significant improvement (P<.001). The postcourse score was related to the accuracy with which the simulator exercises were performed (Spearman rho 0.2664; P<.001). Nearly two-thirds (n=84, 62.6%) of the students said they enjoyed working on the simulator. A total of 79 (58.0%) students felt that they had achieved the course's objective of reproducing ultrasound images. Inadequate connection speed had been a problem for 40.2% (n=54) of students. The integration of an online simulator for the practical learning of ultrasound in remote learning situations has allowed for substantial acquisitions in the psychomotor field of ultrasound diagnosis. Despite the absence of workshops, the students were able to learn and practice how to handle an ultrasound probe to reproduce standard images. This study enhances the value of online programs in medical education, even for practical skills

Necrotizing pneumonia in children: Chest computed tomography vs. lung ultrasound.

The utilization of contrast-enhanced computed tomography (CT) of the chest for the diagnosis of necrotizing pneumonia (NP), a complication of community-acquired pneumonia, is controversial because of the inherent ionizing radiation involved. Over the past few years, the growing availability of bedside Lung Ultrasound (LUS) devices has led to increased use of this nonionizing imaging method for diagnosing thoracic pathology, including pneumonia. The objectives of this study were as follows: first, to compare the performance of LUS vs. CT in the identification of certain radiological signs of NP, and second, to determine whether LUS could replace CT in the diagnosis of NP. We compared retrospectively the CT and LUS images of 41 patients between 2005 and 2018 in whom at least one contrast-injected chest CT scan and one LUS had been undertaken fewer than 7 days apart. Pleural effusions were demonstrated almost systematically (100% on CT vs. 95.8% on LUS). Visualization of septations in pleural effusions was clearly superior on LUS (20.4% on CT vs 62.5% on LUS). Concerning the detection of necrosis, we observed a strong correlation between LUS and the gold-standard CT (95.8% on LUS vs. 93.7% on CT). Parenchymal cavities were more easily detected on CT than on LUS (79.1 vs. 35.4%). LUS has shown to be as effective as CT in the diagnosis of NP. The use of CT in patients with NP could be limited to the detection of complications such as bronchopleural fistulae in unfavorably evolving diseases

Gated cardiac CT in infants: What can we expect from deep learning image reconstruction algorithm?

ECG-gated cardiac CT is now widely used in infants with congenital heart disease (CHD). Deep Learning Image Reconstruction (DLIR) could improve image quality while minimizing the radiation dose. To define the potential dose reduction using DLIR with an anthropomorphic phantom. An anthropomorphic pediatric phantom was scanned with an ECG-gated cardiac CT at four dose levels. Images were reconstructed with an iterative and a deep-learning reconstruction algorithm (ASIR-V and DLIR). Detectability of high-contrast vessels were computed using a mathematical observer. Discrimination between two vessels was assessed by measuring the CT spatial resolution. The potential dose reduction while keeping a similar level of image quality was assessed. DLIR-H enhances detectability by 2.4% and discrimination performances by 20.9% in comparison with ASIR-V 50. To maintain a similar level of detection, the dose could be reduced by 64% using high-strength DLIR in comparison with ASIR-V50. DLIR offers the potential for a substantial dose reduction while preserving image quality compared to ASIR-V

Pulse Oximetry as an Aid to Rule Out Pneumonia among Patients with a Lower Respiratory Tract Infection in Primary Care.

Guidelines recommend chest X-rays (CXRs) to diagnose pneumonia and guide antibiotic treatment. This study aimed to identify clinical predictors of pneumonia that are visible on a chest X-ray (CXR+) which could support ruling out pneumonia and avoiding unnecessary CXRs, including oxygen saturation. A secondary analysis was performed in a clinical trial that included patients with suspected pneumonia in Swiss primary care. CXRs were reviewed by two radiologists. We evaluated the association between clinical signs (heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, abnormal auscultation, and oxygen saturation < 95%) and CXR+ using multivariate analysis. We also calculated the diagnostic performance of the associated clinical signs combined in a clinical decision rule (CDR), as well as a CDR derived from a large meta-analysis (at least one of the following: heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, or abnormal auscultation). Out of 469 patients from the initial trial, 107 had a CXR and were included in this study. Of these, 26 (24%) had a CXR+. We found that temperature and oxygen saturation were associated with CXR+. A CDR based on the presence of either temperature ≥ 37.8 °C and/or an oxygen saturation level < 95% had a sensitivity of 69% and a negative likelihood ratio (LR-) of 0.45. The CDR from the meta-analysis had a sensitivity of 92% and an LR- of 0.37. The addition of saturation < 95% to this CDR increased the sensitivity (96%) and decreased the LR- (0.21). In conclusion, this study suggests that pulse oximetry could be added to a simple CDR to decrease the probability of pneumonia to an acceptable level and avoid unnecessary CXRs

Pathogenic mutations in NUBPL affect complex I activity and cold tolerance in the yeast model Yarrowia lipolytica

Complex I deficiency is a common cause of mitochondrial disease, resulting from mutations in genes encoding structural subunits, assembly factors or defects in mitochondrial gene expression. Advances in genetic diagnostics and sequencing have led to identification of several variants in NUBPL (nucleotide binding protein-like), encoding an assembly factor of complex I, which are potentially pathogenic. To help assign pathogenicity and learn more about the function of NUBPL, amino acid substitutions were recreated in the homologous Ind1 protein of the yeast model Yarrowia lipolytica. Leu102Pro destabilized the Ind1 protein, leading to a null-mutant phenotype. Asp103Tyr, Leu191Phe and Gly285Cys affected complex I assembly to varying degrees, whereas Gly136Asp substitution in Ind1 did not impact on complex I levels nor dNADH:ubiquinone activity. Blue-native polyacrylamide gel electrophoresis and immunolabelling of the structural subunits NUBM and NUCM revealed that all Ind1 variants accumulated a Q module intermediate of complex I. In the Ind1 Asp103Tyr variant, the matrix arm intermediate was virtually absent, indicating a dominant effect. Dysfunction of Ind1, but not absence of complex I, rendered Y. lipolytica sensitive to cold. The Ind1 Gly285Cys variant was able to support complex I assembly at 28°C, but not at 10°C. Our results indicate that Ind1 is required for progression of assembly from the Q module to the full matrix arm. Cold sensitivity could be developed as a phenotype assay to demonstrate pathogenicity of NUBPL mutations and other complex I defects

MR and CT imaging of pulmonary valved conduits in children and adolescents: normal appearance and complications

Introduction: Le Contegra® est un conduit réalisé à partir de veines jugulaires d'origine bovine qui est inséré entre le ventricule droit et l'artère pulmonaire. Il est utilisé dans les malformation cardiaques, lors de la reconstruction de la chambre de chasse du ventricule droit. Le but de notre travail était de décrire en imagerie l'aspect normal et les complications liées à ce type de conduit ainsi que de définir le rôle du CT et de l'IRM dans le suivi post-opératoire des jeunes patients porteurs d'un Contegra®. Patients et méthode: 43 examens de 24 patients (17 garçons et 7 filles; âge moyen: 10.8 ans) porteurs d'un Contegra® ont été étudiés rétrospectivement. Une description anatomique et des mesures des conduits ont été effectuées. Les complications suivantes ont été recherchées : sténose, dilatation, plicature, thrombus ou végétations, calcifications et insuffisance valvulaire. Ces trouvailles ont été corrélées au gradient à travers le conduit obtenu par échographie. Résultats: Le CT et l'IRM ont montré une sténose, une dilatation et une plicature du Contegra® dans respectivement 12, 9 et 7 cas. Le CT a permis d'identifier un thrombus ou des végétations du Contegra® chez 3 patients septiques. Des calcifications du conduit étaient présentes au CT chez 12 patients et une insuffisance valvulaire a été mesurée en IRM chez 3 patients. La comparaison entre CT et/ou IRM a montré une bonne corrélation avec les valeurs de gradients obtenues en échographie lors de sténose du conduit. Conclusion: Le CT et l'IRM apportent des informations additionnelles au sujet de la perméabilité du Contegra et de son aspect post-opératoire, spécialement lorsque l'échographie est non conclusive. Ces 2 techniques permettent de démontrer l'aspect normal du conduit et aident à réaliser une évaluation précise des changements qui surviennent dans les complications postopératoire immédiates et à long terme

Titelbildbeitrag - Bilaterale subkapsuläre Urinome: Ungewöhnliche Ursache einer Page-Niere mit Nierenversagen

Die Page-Niere ist eine relativ seltene, meist reversible Form der sekundären Hypertonie. Im Gegensatz zum Goldblatt-Mechanismus wird der hyperreninämische Hochdruck durch eine Ischämie der Nierenrinde als Folge einer Kompression des Nierenparenchyms durch einen subkapsulären oder perirenalen Prozess, meistens durch Hämatome, verursacht. Seit den anfänglichen Experimenten von Page im Jahr 1939 wurden über 100 Fälle dieses Zustands in der Literatur beschrieben (Dopson SJ et al. Am J Kidney Dis 2009; 54: 334-339). Soweit uns bekannt ist, wurden nur zwei davon durch Urinome verursacht (Patel MR et al. Urology 1984; 23: 585-587; Matlaga BR et al. J Urol 2002; 168: 672). Im 1. Fall musste ein größerer chirurgischer Eingriff (d. h. Nephrektomie) durchgeführt werden, während der 2. Patient mittels retrograder Pyelografie und Setzen eines Harnleiterkatheters behandelt wurde. Hier stellen wir den ungewöhnlichen Fall einer Page-Niere infolge eines beidseitigen subkapsulären Urinoms und akutem Nierenversagen als Komplikation vor. Die Ultraschall- (US) und computertomografischen (CT) Befunde werden beschrieben, wobei auf die sonografisch gesteuerte perkutane Behandlung besonders eingegangen wird