Advanced MRI for Pediatric Brain Tumors with Emphasis on Clinical Benefits

Conventional anatomic brain MRI is often limited in evaluating pediatric brain tumors, the most common solid tumors and a leading cause of death in children. Advanced brain MRI techniques have great potential to improve diagnostic performance in children with brain tumors and overcome diagnostic pitfalls resulting from diverse tumor pathologies as well as nonspecific or overlapped imaging findings. Advanced MRI techniques used for evaluating pediatric brain tumors include diffusion-weighted imaging, diffusion tensor imaging, functional MRI, perfusion imaging, spectroscopy, susceptibility-weighted imaging, and chemical exchange saturation transfer imaging. Because pediatric brain tumors differ from adult counterparts in various aspects, MRI protocols should be designed to achieve maximal clinical benefits in pediatric brain tumors. In this study, we review advanced MRI techniques and interpretation algorithms for pediatric brain tumors.

Multi-detector Spiral CT Manifestations of Pediatric Sacrococcygeal Tumors / 中山大学学报(医学科学版)

[Objective] To evaluate the diagnostic values of multi-detector spiral computed tomography (MDCT) in pediatric sacrococcygeal tumors (SCT) and to improve the diagnostic ability.[Methods] 54 children (22 male and 32 female,age between 1 day and 16 years old) with pathologically confirmed SCT were involved in our study.All of them received 64-row spiral Computed Tomography before surgery,CT characteristics and clinical data were retrospectively analyzed.[Results] Pediatric SCT are more common in female children under four years old,with the germ cell tumors most common,followed by neurogenic tumors.Among the 54 SCT,39cases were malignant and 15 were benign (malignant∶ benign =2.60∶1).In CT image findings,37 cases (68％) were mainly solid mass,with 31 cases confirmed malignant by pathology.8 cases (15％) were mainly cystic,with all of them confirmed benign by pathology.9 cases (17％) were cystic-solid or with obvious necrosis in solid mass,with 8 cases confirmed malignant by pathology.[Conclusion] Malignant pediatric SCT are more common than benign SCT.Most malignant SCT are mainly solid mass or cystic-solid or with obvious necrosis in solid mass,and most benign tumors are mainly cystic.Combined with clinical data,MDCT can help to correctly diagnose SCT before surgery.

Microorganisms and viruses causing diarrhea in infants and primary school children and their relation with age and sex in Zakho city, Kurdistan Region, Iraq.

Background: Diarrheal diseases in children are a major public health concern in developing countries. Diarrheal infection spreads through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene. This study was conducted to investigate the incidence of different microorganisms associated with diarrhea in infants and primary school children and their relation to sex and age in Zakho city, Kurdistan region, Iraq. Methods: During the period from September 2013 to May 2014, 600 diarrheic samples were collected from both sexes and different ages (<2 to 12) years; these samples were subjected to various diagnostic tests in the Microbiology Laboratories/Biology Department/Faculty of Science/University of Zakho. Results: Out of 600/479 were positive for one or more types of microorganisms including 265 (55.32%) males and 214 (44.67%) females. Among the positive 479 samples, the highest rate of prevalence was with both bacteria and parasites (57.33and 57.00%, respectively), followed by viruses (10.33%) and only1.16% with fungi. The most prevalent enteric microorganisms were found to be E. coli (62.5%), followed by E. histolytica (46.19%), G. lamblia (42.10%) and the lowest H. nana (0.87%). The mixed prevalence were documented in 179 (37.36) cases, with the most common correlation between bacteria and parasites in 76 (42.45 %) cases. All ages showed high rates of prevalence with both bacteria and parasites, the highest bacterial cases being among ages >4-8 years (65.38 and 64.07%), while parasites were among >6-10 years (64.67 and 60.11%). High viral prevalence were recorded among ages <2 to 6 years with the peak among <2 years (40.54%). Conclusions: From this study we conclude that about 57% of diarrheal cases were associated with bacteria, parasites, and viruses with E. coli, E. histolytica, G. lamblia and rotavirus as leading microorganisms. The mixed prevalence with two or more microorganisms was documented in 179 (37.36%) out of 479 positive samples and the rate of microbial prevalence was found to be gender and age dependent.

Drug utilization study in the inpatients of pediatric department of a tertiary care hospital.

Background: Infants and children constitute a large proportion of the population in developing countries. In Gujarat, studies on drug use patterns in the pediatric age group are lacking in the Saurashtra region hospitals. The objective was to study demographical information and the utilization pattern in the in patients of the pediatric ward. Methods: A cross-sectional, observational drug utilization study was carried out over a period of 6 months in 630 pediatric inpatients of the pediatric department of Guru Gobind Singh Hospital, Jamnagar, a tertiary care teaching hospital. Analyzed data included demographic details and drugs prescribed in respective patients. Results: Most commonly affected age group was 1-5 years, boys in 62.06% and girls in 37.94% and 40.16% were admitted in the pediatric ward. Acute gastroenteritis and pneumonia had the highest admission rate with 31.90% and 22.38%, respectively. The majority of children were prescribed 5-6 drugs. Ceftriaxone (64.92%) was the top most frequently prescribed antibiotic, followed by amoxicillin (49.21%). Prescribing drugs were mainly from essential drug list (64.44%) and by generic names (61.89%). Drugs prescribed orally in 66.10% and by injections in 33.90%. Conclusion: It is quite evident that significantly large number of children were from 1 to 5 year age group. The majority of the children were admitted in inpatients of the pediatric ward for acute gastroenteritis, followed by pneumonia and meningitis. Most frequently prescribed antibiotic group was cephalosporin, followed by penicillin group.

Whole-Body MRI in Children: Current Imaging Techniques and Clinical Applications

Whole-body magnetic resonance imaging (MRI) is increasingly used in children to evaluate the extent and distribution of various neoplastic and non-neoplastic diseases. Not using ionizing radiation is a major advantage of pediatric whole-body MRI. Coronal and sagittal short tau inversion recovery imaging is most commonly used as the fundamental whole-body MRI protocol. Diffusion-weighted imaging and Dixon-based imaging, which has been recently incorporated into whole-body MRI, are promising pulse sequences, particularly for pediatric oncology. Other pulse sequences may be added to increase diagnostic capability of whole-body MRI. Of importance, the overall whole-body MRI examination time should be less than 30-60 minutes in children, regardless of the imaging protocol. Established and potentially useful clinical applications of pediatric whole-body MRI are described.

Coronary Artery Imaging in Children

Coronary artery problems in children usually have a significant impact on both short-term and long-term outcomes. Early and accurate diagnosis, therefore, is crucial but technically challenging due to the small size of the coronary artery, high heart rates, and limited cooperation of children. Coronary artery visibility on CT and MRI in children is considerably improved with recent technical advancements. Consequently, CT and MRI are increasingly used for evaluating various congenital and acquired coronary artery abnormalities in children, such as coronary artery anomalies, aberrant coronary artery anatomy specific to congenital heart disease, Kawasaki disease, Williams syndrome, and cardiac allograft vasculopathy.

Rehabilitation and Coping with Disabilities in Infants and Children

Rehabilitation of infants and children with disabilities focuses on enhancing their abilities to perform tasks and participate meaningfully in everyday activities. The International Classification of Functioning, Disability and Health (ICF) provides a rehabilitative model which characterises the child’s functioning and health in the context of relevant personal and environmental factors that can facilitate or hinder performance. Using the ICF framework, the general principles of rehabilitating infants and children with disabilities are: 1. Family-centred care with effective communication and collaboration of members within the multi-disciplinary team; 2. Address fundamental needs of a growing infant and child; 3. Intervention to improve body functions and structures; 4. Encourage participation in patient and family meaningful activities. The primary health care provider plays an integral role in managing infants and children with disabilities.

Diseases that Result in Disability in Infants and Children – An Update

Disability in children can be broadly classified into physical and mental disabilities and there are many conditions that result in this. Physical disability is often present in children with cerebral palsy or neuromuscular disorders. With mental disability, the children are not able to learn self help skills and remain dependent on their caregivers for most of the activities of daily living. An extension of this group would include those with moderate to severe autism. In paediatrics, many conditions result in both forms of disabilities with greater consequence and burden to their families. Thus, early rehabilitation incorporating motor learning, education and vocational training, which are inclusive of all aspects of health and neuro-development, is the new paradigm shift. The current emphasis is focused on health and function, and not the disability. Rehabilitation plans are made toward the goals of life in school and community; participation and if possible, contribution to the society in adulthood. Long term care if needed, remains a most challenging task for all involved in the management of children with severe disabilities.

Advanced Magnetic Resonance Imaging for Pediatric Brain Tumors: Current Imaging Techniques and Interpretation Algorithms / 임상소아혈액종양

Magnetic resonance imaging plays a pivotal role in noninvasive evaluation of pediatric brain tumors before and after treatments. These imaging techniques have continuously evolved and now they are incorporated into imaging protocols dedicated for brain tumors. Advanced magnetic resonance imaging techniques include diffusion-weighted imaging, diffusion tensor imaging, functional imaging, perfusion imaging, spectroscopy, and susceptibility-weighted imaging. In order to maximize their clinical usefulness, fundamental concept and clinical utility of each technique should be recognized not only by radiologists, but also by referring physicians. Because pediatric brain tumors differ from adult brain tumors in various aspects, magnetic resonance imaging protocols should be appropriately tailored to pediatric brain tumors. Another recent trend in magnetic resonance imaging is three-dimensional data acquisition that can allow high-solution isotropic images and shorter examination time. In this article, current magnetic resonance imaging techniques and interpretation algorithms for pediatric brain tumors are reviewed.

Advanced Magnetic Resonance Imaging for Pediatric Brain Tumors: Current Imaging Techniques and Interpretation Algorithms / 임상소아혈액종양

Magnetic resonance imaging plays a pivotal role in noninvasive evaluation of pediatric brain tumors before and after treatments. These imaging techniques have continuously evolved and now they are incorporated into imaging protocols dedicated for brain tumors. Advanced magnetic resonance imaging techniques include diffusion-weighted imaging, diffusion tensor imaging, functional imaging, perfusion imaging, spectroscopy, and susceptibility-weighted imaging. In order to maximize their clinical usefulness, fundamental concept and clinical utility of each technique should be recognized not only by radiologists, but also by referring physicians. Because pediatric brain tumors differ from adult brain tumors in various aspects, magnetic resonance imaging protocols should be appropriately tailored to pediatric brain tumors. Another recent trend in magnetic resonance imaging is three-dimensional data acquisition that can allow high-solution isotropic images and shorter examination time. In this article, current magnetic resonance imaging techniques and interpretation algorithms for pediatric brain tumors are reviewed.

Manejo nutricional na alergia à proteína do leite de vaca / Nutritional management of cow´s milk protein allergy in infants and young children

A alergia à proteína do leite de vaca vem ocupando demais o raciocínio dos pediatras nos últimos anos. Muito provavelmente isso se deve à dificuldade em se reconhecer o quadro clínico e principalmente em estabelecer o melhor tratamento para as crianças acometidas. Um fator agravante é o número enorme de novas fórmulas lácteas que vêm sendo apresentadas ao mercado, sem que o médico consiga acompanhar e avaliar as características de cada uma e muito menos adquirir experiência com o seu uso. Considerando que o princípio básico do tratamento da APLV é a terapia nutricional, esta revisão expõe de maneira bastante prática como deve ser o manejo nutricional dessa patologia. Nunca é demais lembrar que as alterações nutricionais que essas crianças apresentam e podem apresentar devem ser consideradas como emergência nutricional.

Diseases that Result in Disability in Infants and Children – An Update

Disability in children can be broadly classified into physical and mental disabilities, and there are many conditions that result in this. Physical disability is often present in children with cerebral palsy or neuromuscular disorders. With mental disability, the children are not able to learn self-help skills and remain dependent on their caregivers for most of the activities of daily living. An extension of this group would include those with moderate to severe autism. In paediatrics, many conditions result in both forms of disabilities, with greater consequence and burden to their families. Nevertheless, there had been some recent advances in the management of the spasticity in children with cerebral palsy and the beginning of pharmacological treatment for Duchenne muscular dystrophy. Long term care and rehabilitation remains the most challenging task for all involved in the care of disabled children.

Effect of Early Hyperbaric Oxygen on Traumatic Basal Ganglia Infarction in Infants and Children / 中国康复理论与实践

@#Objective To investigate the effect of early hyperbaric oxygen on traumatic basal ganglia infarction in infants and children.Methods 93 cases with basal ganglia infarction after cerebral trauma were reviewed. They were divided into hyperbaric oxygen group (n=60) and control group (n=33). Results 100% of the hyperbaric oxygen group improved, and 93.33% were cured; it was 81.82% and 75.76%in the control group (P<0.05). Conclusion Early hyperbaric oxygen is safe and effective on traumatic basal ganglia infarction in infants andchildren.

Efficacy of 32P and pinyangmycin injection in combination on maxillofacial hemangioma in infants and children / 中华医学美学美容杂志

Objective To explore and evaluate the effect of 32P and pinyangmycin injected in combination for the treatment of maxillofacial hemangioma. Methods The patients were randomly divided into three groups. The first group of patients was treated with 32P; 100 patients were enrolled in this group, of which 37 were male and 63 female. 32P dosage between 0.37 and 0. 74 MBq per cm3 was prepared together with 0.5 ml of 2 %lidocaine, and appropriate normal saline, and then the mixture was injected into hemangioma every two weeks. The second group was given pinyangmycin, and the third group received both 32P and pinyangmycin. The second group included 30 male and 60 female, and the third group 64 male and 136 female. The dose and frequency were given as the same to the first group. Results 88.5 % of patients were cured using both 32P and pinyangmycin, and the cure rate was 77.0 % and 71.7 % with either 32P or pinyangmycin. Conclusion These results prove that 32P and pinyangmycin injected in combination for the treatment of maxillofacial hemangioma is more effective than either 32P or pinyangmycin alone, and furthermore, the method is easy, safe and has less complications.

Optimization of the Scan Protocol for the Reduction of Diaphragmatic Motion Artifacts Depicted on CT Angiography: a Phantom Study Simulating Pediatric Patients with Free Breathing

OBJECTIVE: This study was designed to optimize the scan protocol of CT angiography to reduce diaphragmatic motion artifacts in pediatric patients with free-breathing. MATERIALS AND METHODS: A phantom with twelve tubes with different diameters was constructed. To simulate free-breathing, the phantom was connected to a motor, and the phantom moved along the axis of scan. Scans were performed under several conditions: different pitch (1, 1.5) and gantry rotation time (0.37 and 0.75 sec), and different movement range (1 cm, 3 cm) and rates (20/min, 40/min). For CT scanning, a 16-channel CT scanner was used and fixed factors of the CT protocol were as follows: 100 effective mAs, 80 kVp, reconstruction with a soft-algorithm, beam collimation 16x75 mm, reconstruction thickness of 1 mm, and an interval of 0.5 mm. CT scans were repeated five times. Each tube was evaluated with the use of a grading system (0 for images where tubes were not discriminable and 2 for images where tubes were clearly discriminable). RESULTS: A higher pitch and shorter gantry rotation time produced images with a higher grade. Average grades for the higher pitch (1.5) and faster gantry rotation time (0.37 sec) for each combination of movement were as follows: 1.94 (range 1 cm and rate 20/min), 1.42 (range 1 cm and rate 40/min), 0.86 (range 3 cm and rate 20/min) and 0.52 (range 3 cm and rate 40/min). Average grades for the lower pitch (1) and slower gantry rotation time (0.75 sec) for each combination of movement were 1.08, 0.56, 0.32 and 0.08, respectively. CONCLUSION: The scanning speed and especially the pitch are important parameters for CT scans to overcome a respiratory motion artifact.

Nodular Fasciitis on the Nasolabial Fold in a 5-month-old Infant: A Case Report

We report the case of a 5-month-old infant with a rapidly growing mass on the right nasolabial fold; to our knowledge, this is the youngest infant diagnosed with nodular fasciitis in the literature. Based on the anatomic location, this was a subcutaneous type of nodular fasciitis and it had a mixed cellular and fibrous histologic composition, which is rare in infancy. Here we present periodic ultrasonographic images and MR images, as well as a detailed comparison of the pathologic and radiologic findings.

Neonatal Gastric Web Located in the Body of Stomach: A Case Report

Gastric web is a rare gastric anomaly and almost all the reported cases have been located in the distal antrum. We experienced a case of neonatal gastric web that was located in the body of stomach, and we report the findings of the upper gastrointestinal series and ultrasonography.

Diffusion-Weighted Imaging of Brain Injury Due to Neonatal Hypoglycemia: A Case Report

Profound hypoglycemia results in significant brain injury because glucose is essential for normal brain functioning. We present here a case of transient neonatal hypoglycemia with diffuse brain injury. Magnetic resonance imaging was performed 2 days after onset, and this revealed bilateral regions of restricted diffusion in the parietal, occipital, frontal and temporal lobes. On the T1-weighted images, the regions showed indistinct gray matter-white matter differentiation. There were subtle high signal intensity lesions along the corresponding regions of the FLAIR and T2-weighted images.

Pediatric CT: Understanding of Radiation Dose and Optimization of Imaging Techniques

The number of CT examinations is dramatically increasing due to recent technical advances including multi-slice spiral CT. Although the benefits of CT outweigh the risks of radiation exposure of CT, radiologists should alert to the potential harmful effects of CT and avoid unnecessarily high CT dose, especially for pediatric CT examinations. To accomplish this, we should understand CT radiation dose and be familiar with imaging techniques of reducing CT dose without degrading diagnostic image quality. In addition, it is important to spread this balanced and useful information into CT referring clinicians, radiologists in training, and medical students.

Experiences on Micro-laparoscopic Hernioplasty in Infants and Children: Report of 4500 Cases / 中国微创外科杂志

Objective To analyze the causes and preventions of the perioperative complications of micro-laparoscopic hernioplasty in infants and children with indirect inguinal hernia.Methods From January 1997 to January 2007,4500 infants or children with indirect inguinal hernia,including 702 cases who were complicated with hydrocele testis,were treated by micro-laparoscopic hernioplasty in our hospital.By laparoscopy,the endocycle was sutured circularly under the peritoneum using a self-designed needle.Then,only the peritoneum was ligated.Results No organ injury or complication occurred during the operation.The mean operation time was 9 min(5-13 min).Among the patients,4250 received a follow-up of 7-36 months(mean,25 months).Postoperative complications were found in 132 patients(3.1%),included scrotal gas in 10(0.24%),scrotal hydrocele in 16(0.38%),umbilical hernia in 27(0.64%),extraperitoneal emphysema in 20(0.47%),abdominal wall hematoma at the burr hole in 15(0.35%),foreign body sensation at the suture sites in 30(0.71%),scrotal hematoma in 8(0.19%),and iatrogenic cryptorchism in 6(0.14%).Thirty-five patients had recurrence(0.82%).Conclusions Micro-laparoscopic hernioplasty is a safe and reliable method for indirect inguinal hernia in infants and children.It is important to be familiar with the anatomy of the hernia under a laparoscope and to perform the operation carefully so that to avoid or decrease the perioperative complications.