Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia / Infecção por Streptococcus pneumoniae em crianças com ou sem pneumonia radiologicamente confirmada

Abstract Objective: Community-acquired pneumonia is an important cause of morbidity in childhood, but the detection of its causative agent remains a diagnostic challenge. The authors aimed to evaluate the role of the chest radiograph to identify cases of community-aquired pneumonia caused by typical bacteria. Methods: The frequency of infection by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis was compared in non-hospitalized children with clinical diagnosis of community acquired pneumonia aged 2-59 months with or without radiological confirmation (n = 249 and 366, respectively). Infection by S. pneumoniae was diagnosed by the detection of a serological response against at least one of eight pneumococcal proteins (defined as an increase ≥2-fold in the IgG levels against Ply, CbpA, PspA1 and PspA2, PhtD, StkP-C, and PcsB-N, or an increase ≥1.5-fold against PcpA). Infection by H. influenzae and M. catarrhalis was defined as an increase ≥2-fold on the levels of microbe-specific IgG. Results: Children with radiologically confirmed pneumonia had higher rates of infection by S. pneumoniae. The presence of pneumococcal infection increased the odds of having radiologically confirmed pneumonia by 2.8 times (95% CI: 1.8-4.3). The negative predictive value of the normal chest radiograph for infection by S. pneumoniae was 86.3% (95% CI: 82.4-89.7%). There was no difference on the rates of infection by H. influenzae and M. catarrhalis between children with community-acquired pneumonia with and without radiological confirmation. Conclusions: Among children with clinical diagnosis of community-acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph.

Resumo Objetivo: Avaliar o papel do raios X de tórax na identificação de casos de pneumonia adquirida na comunidade (PAC) causada por agentes bacterianos. Métodos: A frequência de infecção por Streptococcus pneumoniae, Haemophilus influenzae e Moraxella catarrhalis em crianças com PAC não hospitalizadas foi comparada com a presença de confirmação radiológica da pneumonia (n = 249 crianças com pneumonia radiologicamente confirmada e 366 crianças com raios X de tórax normal). Infecção por S. pneumoniae foi diagnosticada com base na resposta sorológica a pelo menos uma dentre oito proteínas pneumocócicas investigadas (aumento ≥ 2 vezes nos níveis de IgG em relação a Ply, CbpA, PspA1 e 2, PhtD, StkP-C e PcsB-N ou aumento≥ 1,5 vez em relação aPcpA). Infecção por H. influenzae e M. catarrhalis foi definida por aumento ≥ 2 vezes nos níveis de IgG específica a antígenos de cada agente. Resultados: Crianças com pneumonia radiologicamente confirmada apresentaram maior taxa de infecção pelo pneumococo. Além disso, a presença de infecção pneumocócica foi um fator preditor de pneumonia radiologicamente confirmada, o que aumenta sua chance de detecção em 2,8 vezes (IC 95%: 1,8-4,3). O valor preditivo negativo do raios X normal para a infecção por S. pneumoniae foi 86,3% (IC95%: 82,4%-89,7%). Não houve diferença nas frequências de infecção por H. influenzae e M. catarrhalis entre crianças com PAC com ou sem confirmação radiológica. Conclusão: Crianças com diagnóstico clínico de PAC submetidas a um raios X de tórax que apresentam confirmação radiológica têm maior taxa de infecção por S. pneumoniae comparadas com as crianças com raios X normal.

Evaluation of Lumber Vertebral Canal at Disc Level in Symptomatic and Asymptomatic subjects: A Radiological Evaluation.

Background: Spinal stenosis is defined as the narrowing of central spinal canal or its lateral recesses. Stenosis of spinal canal becomes important only when it results in interference with the normal functions of the contents of the canal. Narrowing of spinal canal seems to be a normal part of advancing age but certain uncertainties persist as regards to radiological definition of lumbar spinal canal stenosis. Material & Method: The present study was aimed to evaluate the clinical relevance of stenosis of spinal canal through the most recent technique, MRI. Fifty symptomatic and 18 asymptomatic subjects were included. Antero-posterior and transverse diameters of vertebral canal were compared between symptomatic and asymptomatic subjects and statistically analyzed. Results & Discussion: The present study clearly shows that in both symptomatic and asymptomatic subjects there is a gradual decrease in the antero-posterior diameter from above downwards . The minimum anteroposterior and maximum transverse diameter was seen at L4L5 level making this level susceptible to compressive symptomatology. Apparent stenosis was observed in some asymptomatic subjects.

Presence of air in the hepatic portal system in association with umbilical venous catheter malposition / Presença de ar no sistema porta hepático associada a cateter umbilical venoso mal posicionado

The authors report a case of umbilical venous catheter malposition with air in the portal venous system in a preterm neonate. Initially, the hypothesis of necrotizing enterocolitis was considered, but the newborn progressed with no finding of disease and the air disappeared at follow-up radiography. The differential diagnosis of such a finding can avoid unnecessary clinical treatments.

Apresentamos um caso relacionado a cateter umbilical venoso mal posicionado, associado à presença de ar no sistema portal, em um recém-nascido prematuro. A hipótese de enterocolite necrosante foi considerada inicialmente, porém o recém-nascido evoluiu sem achados da doença, tendo o ar desaparecido em radiografia de controle. O diagnóstico diferencial deste achado evita condutas clínicas desnecessárias.

A Radiological Study of Normal Wrist in Korean People / 대한정형외과학회잡지

The wrist, or carpus, is a deformable anatomic entity composed of 8 small carpal bones (scaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapezium and trapezoid) and the surrounding soft-tissue structures. We should get radiological knowledge of normal wrist in order to identify pathology of that. So we measured the several values on AP, PA and lateral roentgenograms of 228 normal wrist(male : 124 cases, femal: 104 cases). The following results were obtained: 1. Scapholunate gap : 1.4±0.5mm 2. Ulnar variance : 1.3 ±1.7mm, Positive variance … 59.7%, Neutral variance … 25.4% 3. Carpal height ratio : 0.543 ±0.078 4. Carpal ulner distance ratio : 0.32 ±0.04 5. Scapholunate angle : 45.8 ± 8.7° 6. Capitatolunate angle : 19.3 ± 8.2° 7. Radiolunate angle : 8.9 ± 4.7° 8. Ulnar tilt: 23.5 ± 3.3° 9. Volar tilt: 12.0 ± 4.7°

Corrosive oesophagitis: Radiological study.

Thirty-six oesophagograms of 24 patients after ingestion of 75-90% formic acid in suicide attempts were reviewed. AII oesophagograms were obtained in the acute, subacute, and chronic phases. In the acute and suhacute phases, the radiographic findings consisted of mucosal oedema, submucosal oedema or haemorrhages, ulcerations, sloughing of the moucosa, atony and dilatiation. Stricture of the oesophsgus was present in the chronic phase. The severity of the corrosive oesophagitis was considerably related to the concentration, amount, and duration of contact between the caustic agent and the oesophageal mucosa.