Senos dérmicos craneales en pediatría: presentación, diagnóstico, complicaciones y tratamiento. Experiencia de un hospital pediátrico de nivel III / Cranial dermal sinuses in pediatrics: Presentation, diagnosis, complications, and management. Experience at a tertiary care children's hospital

Introducción. El seno dérmico cefálico es un tractotubular formado por una separación incompleta entre el ectodermo neural y el ectodermo epitelial;puede tener complicaciones infecciosas. Existen reportes aislados de esta patología. Objetivo: describir una serie de pacientescon seno dérmico craneal, las formas depresentación, el diagnóstico, el tratamiento y las complicaciones. Población y métodos. Estudio observacionaldescriptivo de una serie de pacientes pediátricos con seno dérmico cefálico atendidos en unhospital pediátrico de nivel III entre 2014 y 2019. Resultados. se incluyeron 18 pacientes. La clínicade presentación fue, en 12 casos, una lesión puntual en el cuero cabelludo, hipertensiónendocraneana en 4 casos, ataxia en 1 caso y lesión puntual con fístula en 1 caso. La mitad presentó síntomas de infección. La localización fue en la línea media sobre el hueso occipital en 13 casos, en la línea media sobre el hueso frontal en 3 casos y en la línea media interparietal en 2 casos. En 5 casos se encontró asociada una imagen extracraneana y, en 11 casos, una complicación intracraneana. Ningún paciente presentó recidiva de la lesión y en todos se realizó un solo procedimiento quirúrgico. Conclusiones. Los senos dérmicos en esta serie se presentaron como lesiones puntuales en cuerocabelludo. La localización más frecuente fue a nivel occipital sobre línea media y, en más de la mitad, atravesaba el hueso. El tratamiento de elección fue la exéresis completa del seno dérmicoy las lesiones asociadas. Ante la presencia de senos dérmicos sintomáticos o asociados alesiones intracraneanas, la cirugía se realizó de urgencia.

Introduction. A cranial dermal sinus is a tubular tract resulting from the incomplete separation of the epithelial ectoderm from the neuroectoderm which may lead to infectious complicationsThere have been isolated reports of this condition. Objective. To describe a series of patients with cranial dermal sinus, its presentation, diagnosis, management, and complications. Population and methods. Observational,descriptive study of a series of pediatric patients with cranial dermal sinus treated at a tertiary care children's hospital between 2014 and 2019. Results. A total of 18 patients were included. Theclinical presentation was a specific lesion on the scalp in 12 cases, intracranial hypertension in 4, ataxia in 1, and a specific lesion with fistula tract in 1. Half of patients had symptoms of infection. The lesion was located in the midline of the occipital bone in 13 cases; in the midline of the frontal bone in 3 cases; and in the interparietal midline in 2 cases. The dermal sinus was associated with anextracranial image in 5 cases and an intracranial complication in 11 cases. No patient hadrecurrence and only one surgery was performed in all of them. Conclusions. In this series, dermal sinusespresented as specific lesions on the scalp. The most common site was the occipital midline, and more than 50% of these extended through the bone. The treatment of choice was complete resection of dermal sinus and associated lesions. An emergency surgery was performed when the dermal sinus was symptomatic or associated with intracranial lesions.

Malignidad o no de las masas anexiales de gran tamaño. Reporte de caso / Malignancy or not of large adnexal masses. Case report

Resumen ANTECEDENTES: Una masa anexial es una prominencia de localización cercana, o relacionada con los órganos reproductores femeninos y sus tejidos circundantes. En la práctica clínica, las masas anexiales representan un dilema en cuanto a su diagnóstico y tratamiento. El diagnóstico suele ser fortuito, luego de un hallazgo en el examen ginecológico o en estudios de imagen. CASO CLÍNICO: Paciente de 29 años, con antecedentes de tres embarazos, dos partos y un aborto, sin comorbilidades asociadas. El último parto se registró en enero del 2021. Acudió a consulta debido a un cuadro de dolor en la parte inferior del abdomen, tipo cólico, de intensidad progresiva 7/10 en la escala visual análoga, irradiado a la zona lumbar, asociado con episodios eméticos, sin ningún otro síntoma, de una semana de evolución. Al ingreso a Urgencias sus condiciones generales se estimaron aceptables: hidratada, álgica, sin alteraciones cardiacas ni pulmonares, sin afectación neurológica ni adenopatías. CONCLUSIONES: Es importante individualizar cada caso, determinar las características ecográficas y llevar a cabo un tratamiento escalonado conforme a la respuesta clínica de las pacientes. La bibliografía y este reporte comprueban la utilidad de los nuevos índices propuestos por la IOTA para el cálculo del riesgo de malignidad de masas complejas anexiales. En este reporte de caso se logra observar una correcta relación entre la sospecha preoperatoria y el desenlace histológico final.

Abstract BACKGROUND: An adnexal mass is a prominence of location close to, or related to, the female reproductive organs and their surrounding tissues. In clinical practice, adnexal masses represent a diagnostic and treatment dilemma. Diagnosis is usually fortuitous, following a finding on gynecological examination or imaging studies. CLINICAL CASE: 29-year-old patient, with a history of three pregnancies, two deliveries and one miscarriage, with no associated comorbidities. The last delivery was recorded in January 2021. She came for consultation due to a picture of pain in the lower abdomen, colic type, of progressive intensity 7/10 on the visual analog scale, radiating to the lumbar area, associated with emetic episodes, without any other symptoms, of one week of evolution. On admission to the emergency department, her general condition was considered acceptable: hydrated, energetic, without no cardiac or pulmonary alterations, without neurological involvement or lymphadenopathies. CONCLUSIONS: It is important to individualize each case, determine the ultrasound characteristics and carry out a stepwise treatment according to the clinical response of the patients. The literature and this report prove the usefulness of the new indexes proposed by IOTA for the calculation of the risk of malignancy of complex adnexal masses. In this case report a correct relationship between preoperative suspicion and final histologic outcome is observed.

Comparison of laboratory and radiological findings of pregnant and non-pregnant women with covid-19

Abstract Objective Covid-19 became a pandemic, and researchers have not been able to establish a treatment algorithm. The pregnant population is also another concern for health care professionals. There are physiological changes related to pregnancy that result in different laboratory levels, radiological findings and disease progression. The goal of the present article is to determine whether the laboratory results and radiological findings were different in non-pregnant women (NPWs) of reproductive age and pregnant women (PWs) diagnosed with the Covid-19 infection. Methods Out of 34 patients, 15 (44.11%) PWs and 19 (55.8%) NPWs were included in the study. Age, comorbidities, complaints, vitals, respiratory rates, computed tomography (CT) findings and stages, as well as laboratory parameters, were recorded from the hospital database. Results Themean age of the PWs was of 27.6 ± 0.99 years, and that of the NPWs was of 37.63 ± 2.00; when agewas compared between the groups, a statistically significant difference (p=0.001) was found. The mean systolic blood pressure of the PWs was of 116.53 ± 11.35, and that of the NPWs was of 125.53 ± 13.00, and their difference was statistically significant (p=0.05). The difference in the minimum respiratory rates of the patients was also statistically significant (p=0.05). The platelet levels observed among the PWs with Covid-19 were lower than those of the NPWs (185.40 ± 39.09 x 109/mcL and 232.00 ± 71.04 x 109/mcL respectively; p=0.05). The mean D-dimer value of the PWs was lower in comparison to that of the NPWs (p<0.05). Conclusion The laboratory findings and imaging studiesmay differ between pregnant and non-pregnant populations. It is important to properly interpret these studies. Future studies with a higher number of patients are required to confirm these preliminary data.

Bazo metastásico de un adenocarcinoma de endometrio. Presentación de un caso / Splenic metastasis from endometrial adenocarcinoma. A case presentation

Introducción: La metástasis esplénica de un carcinoma endometrial es un acontecimiento clínico raro, con solo 13 casos documentados en la literatura, revisada. La evolución de esta metástasis, en una paciente atendida, en nuestra Institución, fue el motivo para publicar este trabajo. Hay otras enfermedades oncológicas que en su evolución de progresión o recaída cursan con este tipo de cuadro clínico donde el tratamiento quirúrgico es fundamental y así complementar con tratamiento de quimioterapia. Se hizo una revisión en publicaciones cubanas no se encontró reporte del tema. Objetivo: Presentar un caso con un adenocarcinoma de endometrio tipo endometroide que metastiza al bazo con histología de células claras. Presentación: Paciente de 45 años, con diagnóstico de adenocarcinoma de endometrio con estadiamiento quirúrgico pT3A Nx Mo etapa IIIA Grado 2; este estadiamiento es el anterior a 2009, llevó su tratamiento quirúrgico y radioterapia complementaria, controlada por 21 meses. En consulta de seguimiento se diagnostica metástasis al bazo, por lo que se realiza esplenectomía y es tratada con quimioterapia; fue atendida por el equipo multidisciplinario de ginecología oncológica; las investigaciones realizadas estuvieron basadas en inmuhistoquimica, imageneología y tratamiento de soporte cuando lo necesitó. Conclusiones: La metástasis esplénica por un cáncer de endometrio es rara, es el primero reportado en Cuba, los estudios inmuhistoquímicos y de imágenes son fundamentales(AU)

Introduction: Splenic metastasis from endometrial carcinoma is a rare clinical event with only 13 documented cases in the literature reviewed. The evolution of a patient with this metastasis attended in our institution was the reason that motivated us to publish this work. There are other oncological diseases that are accompanied by this clinical picture during their evolution of progression where surgical treatment complemented with chemotherapy treatment is essential. A literature review was carried out in Cuban publications, but no reports on the topic were found. Objective: The aim of this work is to present an endometroid type case endometrium adenocarcinoma which metastasizes to the spleen with clear cell histology. Case presentation: Forty-five-year-old patient with diagnosis of endometrium adenocarcinoma with surgical stage pT3a Nx Mo stage IIIA Grade 2; this quantification was defined before 2009. The patient underwent surgical treatment which was complemented with radiotherapy and then followed for 21 months. In the follow-up consultation, spleen metastasis was diagnosed; so she underwent splenectomy and was treated with chemotherapy. She was treated by the multidisciplinary gynecologic oncology team; the investigations performed were based on immuhistochemistry, imaging, and supportive treatment whenever needed. Conclusions: Splenic metastasis from endometrial cancer is rare; it is the first case reported in Cuba. Immuhistochemical and imaging studies are essential(AU)

Importancia de la neuroimagen en la anoftalmia/microftalmia congénita neonatal: a propósito de un caso / Importance of neuroimaging in neonatal congenital anophthalmia/microphthalmia: a case report

Introducción: La Anoftalmia/Microftalmia es una malformación ocular congénita que se caracteriza por la reducción variable del volumen del globo ocular, la misma requiere de estudios imagenológicos para un diagnóstico más preciso. Objetivo: Demostrar la importancia de la neuroimagen en el diagnóstico y orientación de la microftalmia/anoftalmia neonatal congénita bilateral. Presentación del caso: Se hace referencia a un recién nacido con diagnóstico clínico de anoftalmia/microftalmia de manera inicial que después de realizar estudios de neuroimagen se constataron otras malformaciones del sistema nervioso central que permitieron orientar el diagnóstico hacia un síndrome genético definido. Durante el examen físico inicial se constató hipertelorismo, orejas de implantación baja, fisura palatina, ano anterior y ausencia de los globos oculares en ambos lados. La Resonancia magnética nuclear mostró esbozos de cristalinos rudimentarios, ubicados en zona atípica y esbozo de nervio óptico incompleto del lado derecho. No se observaron globos oculares. Observándose además múltiples imágenes de aspecto quístico bilaterales en las áreas orbitarias que desplazan los cristalinos rudimentarios por conflicto de espacio. Este paciente requirió estudios de neuroimagen para determinar si se trataba de una anoftalmia/microftalmia y para orientar el diagnóstico de displasia septo-óptica que organizó el pensamiento clínico hacia un posible Síndrome de Morsier. En este caso se realizó diagnóstico diferencial con otras causas asociadas a estas malformaciones oculares. Conclusiones: Los estudios imagenológicos del cerebro de los pacientes con anoftalmia / microftalmia en la etapa neonatal permiten orientar un diagnóstico preciso y precoz que favorece una intervención multidisciplinaria temprana(AU)

Introduction: Anophthalmia/microphthalmia is a congenital eye malformation that is characterized by the variable reduction of the volume of the ocular globe, which requires imaging studies for a more precise diagnosis. Objective: To demonstrate the importance of neuroimaging in the diagnosis and management of neonatal congenital bilateral anophthalmia/microphthalmia. Case Presentation: We describe the case of a newborn with an initial clinical diagnosis of anophthalmia/microphthalmia in which, after carrying out neuroimaging studies, other malformations of the central nervous system were confirmed, allowing to guide the diagnosis towards a defined genetic syndrome. During the initial physical exam, hypertelorism, low set ears, palatine fissure, anterior anus, and absence of the ocular globes in both sides were verified. The magnetic resonance imaging showed signals of rudimentary crystalline located in an atypical area, and signals of incomplete optic nerve of the right side. Ocular globes were not observed. Multiple cyst-like bilateral images were also observed in orbital areas, displacing the rudimentary crystalline lens due to space limitations. Discussion: This patient required neuroimaging studies to determine if she had an anophthalmia/microphthalmia and present a guide for the diagnosis of septo-optic dysplasia that organized the clinical thinking towards a possible Morsier Syndrome. In this case, a differential diagnosis with other causes associated to these ocular malformations was made. Conclusions: The imaging studies of the brain of the patients with anophthalmia/microphthalmia in the neonatal period allows to guide a precise and early diagnosis that favors an early multidisciplinary intervention(AU)

Point-of-care Ultrasound in Primary Care in Japan: Current Situation and Future Perspectives / 日本プライマリ・ケア連合学会誌

Point-of-care ultrasound (POCUS) has become increasingly employed in recent years. POCUS is the concept of quickly assessing for conditions using ultrasound based on the patient history and physical examinations to make a clinical decision in a timely manner. This concept has been developed and widely used in emergency medicine and other specialties, and has spread to primary care over the past several years. In Japan, POCUS is not well-known in primary care, but the importance of primary care physicians using ultrasound has been reported since the 1990s. However, many physicians depend on higher imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), instead of ultrasound. Although the benefits of integrating POCUS into primary care have been documented, the barriers of POCUS being employed by primary care physicians include a shortage of educational resources and time during busy practice. As primary care settings in Japan vary, such as clinics, hospitals and patient homes, the indications and required skills for POCUS differ. A standardized training curriculum for POCUS needs to be developed according to the primary care setting.

Mindfulness-based intervention to prevent relapse and relevant imaging studies / 上海交通大学学报（医学版）

Drug abuse is an important issue in China, while there is no effective drug to control the craving, which is the main reason that leads to the relapse. Mindfulness-based relapse prevention, as a novel treatment approach, has been used in the treatment of drug dependence, and a number of researches on this topic have been conducted. The current paper provided a review of recent clinical researches and relevant imaging studies to discuss the application of mindfulness-based relapse prevention, which hopes to provide theoretical basis for future study.

Neonatal Aerophagia Dilemma – A Gastrointestinal Functional Disorder: Role of Imaging Studies.

Aerophagia is excessive swallowing of air which goes to stomach through oesophagus and causes abdominal distention. This may alert the parents of pediatric age group especially neonates and causes anxiety. Although it’s a functional condition, the clinical presentation can suggest malabsorption or obstruction, leading to unnecessary tests and investigations. We present a 15 days -old neonate who was brought to the pediatric surgical emergency with one such condition and was managed conservatively after imaging studies ruled out any underlying pathology. The case was discharged without any surgical intervention.

Clinical Guideline for Childhood Urinary Tract Infection (Second Revision)

To revise the clinical guideline for childhood urinary tract infections (UTIs) of the Korean Society of Pediatric Nephrology (2007), the recently updated guidelines and new data were reviewed. The major revisions are as follows. In diagnosis, the criterion for a positive culture of the catheterized or suprapubic aspirated urine is reduced to 50,000 colony forming uits (CFUs)/mL from 100,000 CFU/mL. Diagnosis is more confirmatory if the urinalysis is abnormal. In treating febrile UTI and pyelonephritis, oral antibiotics is considered to be as effective as parenteral antibiotics. In urologic imaging studies, the traditional aggressive approach to find primary vesicoureteral reflux (VUR) and renal scar is shifted to the targeted restrictive approach. A voiding cystourethrography is not routinely recommended and is indicated only in atypical or complex clinical conditions, abnormal ultrasonography and recurrent UTIs. 99mTc-DMSA renal scan is valuable in diagnosing pyelonephritis in children with negative culture or normal RBUS. Although it is not routinely recommended, normal scan can safely avoid VCUG. In prevention, a more natural approach is preferred. Antimicrobial prophylaxis is not supported any more even in children with VUR. Topical steroid (2-4 weeks) to non-retractile physiologic phimosis or labial adhesion is a reasonable first-line treatment. Urogenital hygiene is important and must be adequately performed. Breast milk, probiotics and cranberries are dietary factors to prevent UTIs. Voiding dysfunction and constipation should be properly treated and prevented by initiating toilet training at an appropriate age (18-24 months). The follow-up urine test on subsequent unexplained febrile illness is strongly recommended. Changes of this revision is not exclusive and appropriate variation still may be accepted.

The knowledge about diagnostic imaging methods among primary care and medical emergency physicians / O conhecimento dos médicos da atenção primária à saúde e da urgência sobre os exames de imagem

Objective To evaluate the knowledge about diagnostic imaging methods among primary care and medical emergency physicians. Materials and Methods Study developed with 119 primary care and medical emergency physicians in Montes Claros, MG, Brazil, by means of a structured questionnaire about general knowledge and indications of imaging methods in common clinical settings. A rate of correct responses corresponding to ≥ 80% was considered as satisfactory. The Poisson regression (PR) model was utilized in the data analysis. Results Among the 81 individuals who responded the questionnaire, 65% (n = 53) demonstrated to have satisfactory general knowledge and 44% (n = 36) gave correct responses regarding indications of imaging methods. Respectively, 65% (n = 53) and 51% (n = 41) of the respondents consider that radiography and computed tomography do not use ionizing radiation. The prevalence of a satisfactory general knowledge about imaging methods was associated with medical residency in the respondents' work field (PR = 4.55; IC 95%: 1.18-16.67; p-value: 0.03), while the prevalence of correct responses regarding indication of imaging methods was associated with the professional practice in primary health care (PR = 1.79; IC 95%: 1.16-2.70; p-value: 0.01). Conclusion Major deficiencies were observed as regards the knowledge about imaging methods among physicians, with better results obtained by those involved in primary health care and by residents. .

Propuesta de aplicación para el registro de estudios imagenológicos de modalidades no DICOM / A proposal of application for registering non-DICOM imaging studies

Actualmente existen numerosos equipos de adquisición de imágenes y modalidades médicas que no generan ficheros en formato DICOM. La presente investigación tiene como objetivo la propuesta de desarrollo de una aplicación para el registro de estudios imagenológicos que posibilite la visualización, la conversión a formato DICOM, la conformación de un reporte diagnóstico y el envío de las imágenes generadas por todas las modalidades médicas no DICOM. Se propone el desarrollo de la misma sobre la plataforma .NET con lenguaje de programación C#. La aplicación propuesta posibilita el crecimiento de la historia clínica imagenológica del paciente con la inclusión digital de todas las modalidades y agilizará en gran medida el proceso de atención en las instituciones de salud donde se realice diagnóstico por imágenes. Se presupone un ahorro importante al país al evitar la reposición y la compra de nuevos equipos y de materiales gastables(AU)

At the present time, there are several imaging equipment and medical procedures that don't generate files in DICOM format. This research aims to develop an application for registration of imaging that enables viewing, conversion to DICOM format, the creation of a diagnostic report and sending the images generated by all non-DICOM medical modalities. The application will be developed in the .NET platform with C # programming language. The application would allow the growing of the medical imaging history of the patient with the digital inclusion of all modalities. This application also greatly speeds up the process of care in health institutions where imaging diagnostic is performed. This work avoids the replacement and purchase of new equipment and consumable materials to the country(AU)

Estudios de imagenes y pruebas funcionales renales / Imaging and functional studies in urinary tract infections

Las infecciones del tracto urinario son causa frecuente de morbilidad en la edad pediátrica y un porcentaje importante de ellas se asocian con malformaciones de las vías urinarias, por lo que su temprana detección y manejo adecuado podría incidir positivamente sobre la prevención de cicatrices renales, hipertensión arterial y enfermedad renal crónica. La importancia de los métodos de imágenes radica en la posibilidad de identificar precozmente aquellos niños con factores de riesgo de desarrollar cicatrices renales, permitiendo prevenir la progresión del daño preexistente. El protocolo inicial de estudios debería incluir ultrasonido renovesical, uretrocistografía miccional y gammagrama renal con DMSA. En esta revisión se comentan adicionalmente, las pruebas funcionales necesarias para determinar el grado de afectación glomerular y tubular como consecuencia de las infecciones urinarias

Urinary tract infections are frequent causes of morbidity in children and a significant percentage of them are associated with malformations of the urinary tract. Their early detection and proper management could have a positive impact on the prevention of scarring, hypertension and chronic renal disease. The importance of imaging methods is the possibility to identify those children with risk factors for the development of renal scarring, which would allow prevention of the progression of renal damage. The initial study protocol should include renovesical ultrasound, cystography and DMSA renal scintigraphy. This review also discusses the necessary functional test to assess the degree of glomerular and tubular involvement as consequence of urinary tract infections

Childhood Urinary Tract Infection

Childhood UTI is a common bacterial infection in children and frequently associated with urinary tract anomaly and high recurrent rate. Recurrent UTI and even the first UTI, if not diagnosed and untreated, may lead to serious renal scarring, a cause of childhood hypertention and end stage renal failure. It is very important to prevent the sequence of recurrent UTI and the development of renal scarring from the first UTI. However, early diagnosis is very difficult because the symptoms and signs are non-specific in young children and commonly presented with high fever only. In young infants with unexplained high fever, urinalysis and urine culture should be considered for early diagnosis. Emperic antibiotic treatment should be initiated in suspicious UTI and imaging studies of the urinary tract should be performed for the evaluation of urinary tract anomaly and renal scar in confirmed cases of UTI. Antimicrobial prophylaxis has been the common clinical practice in children with high risk factors for recurrent UTI and renal scar. In summary, early diagnosis and proper management of childhood UTI are very important to prevent hypertention and end stage renal disease by renal scar.

Evaluation of Imaging Studies in Male Infants less than 3 Months after First Urinary Tract Infection

PURPOSE : To evaluate the frequency of urinary tract anomalies in male neonates less than 3months old who presented with urinary tract infection(UTI) and to evaluate a appropriate imaging approach after first UTI. MATERIALS AND METHODS : During a period of 5 years, from March 1994 to February 1999, 65 male infants less than 3months old(range: 4-92 days, mean: 43 days) with UTI were evaluated. Ultrasound(US) and Voiding cystourethrogram(VCUG) were done in 60 patients. Due to refusal and technological problem, 5 patients were missed. 99mTc-dimercaptosuccinic acid renal scan (99mTc-DMSA renal scan) was recommended to most patients but performed in 40 patients. Renal scan was performed at least 3 months later after urinary tract infection. RESULTS : Urinary tract anomalies were found in 26 of 65 infants. Twenty-six had vesicoureteral reflux(VUR), two had both VUR and double ureter, two had both VUR and posterior urethral valve. In patients with VUR, eight had renal scar or renal atrophies. In case of renal scar or atrophy, grades of VUR were III or above. CONCLUSION : We suggest that US and VCUG should be routinely performed in infants(<3months)with first UTI. 99mTc-DMSA renal scan should be performed only when renal parenchymal damage was observed in US and VUR grade III or above in VCUG.