ABSTRACT
BACKGROUND: Clinical importance of sexual abuse in children has rapidly expanded in recent years, but despite of it, the lack of medical signs in the vast majority of sexual abuse cases, makes it difficult to assess. Given that, owing to our prior experience in endosonography (EUS) of the anal canal in child with anorectal malformations, we wanted to test EUS as a diagnostic method of sexual abuse in a child. PURPOSE: The purpose of our study is to present our experience in the use of anorectal EUS among children with suspected sexual abuse. MATERIALS/METHODS: We present 40 consecutive patients (34 boys and 6 girls, age: 10months-13years) recruited from April 2010 to December 2012, with suspected sexual abuse those made a transrectal EUS. RESULTS: The procedure was well-tolerated in all patients without complications. Rectoanal EUS findings were normal in 27 patients and showed a partial interruption in the external anal sphincter in 8, scars in 2, double rail image in 2, and rectal wall hematoma in 1. CONCLUSIONS: The interpretation of findings in children depends of historical, physical, and laboratory findings. We believe that anal EUS is another aid in the constellation of clinical factors that could help in diagnostic of sexual abuse.
Subject(s)
Anal Canal/diagnostic imaging , Child Abuse, Sexual/diagnosis , Endosonography , Rectum/diagnostic imaging , Adolescent , Anal Canal/injuries , Anal Canal/pathology , Child , Child, Preschool , Female , Humans , Infant , Male , Rectum/injuries , Rectum/pathologyABSTRACT
BACKGROUND: The use of ultrasonography increased the frequency of diagnosis of cholelithiasis in childhood. AIM: To determine the clinical and laboratory features and follow up of children with biliary stones. PATIENTS AND METHODS: Twenty six children (13 male, aged 1 month to 14 years) were prospectively enrolled. RESULTS: Nine children had a past medical history of factors potentially predisposing to stones. A clinical presentation with vomiting (50%), abdominal pain (46%) and jaundice (23%) was the most common indication for surgery. The diagnosis was based on abdominal ultrasound in all children. Cholecystectomy was performed in 15 children (laparoscopy in 13 and open surgery in 2). Children who underwent surgery were older than those who did not undergo surgery (p < 0.001), but they did not have differences in liver function tests. Eight children had pigmented stones and seven had cholesterol stones. CONCLUSIONS: In our patients, neither family history nor laboratory tests were useful in the diagnosis as well as in the clinical decision of surgery, which was based on symptoms. The presence of cholesterol stones in a high proportion of these children may be a unique situation in Chile, considering the high prevalence of this disease in the adult population.
Subject(s)
Cholelithiasis/diagnosis , Adolescent , Child , Child, Preschool , Cholelithiasis/diagnostic imaging , Cholelithiasis/surgery , Cohort Studies , Female , Humans , Infant , Male , Prospective Studies , UltrasonographyABSTRACT
La etiopatogenia de la enterocolitis necrotizante parece ser multifactorial. Es probable que existan dos formas distintas de ella: la de recién nacidos de pretérmino y la de los de término, en las cuales estos factores tendrían distinta preponderancia. En el primer caso, la prematurez con inmadurez del intestino y de la respuesta inmune jugaría un rol fundamental, mientras en el segundo tendrían mayor relevancia los fenómenos hipóxicos. A pesar que los mediadores de la inflamación, especialmente el factor activador plaquetario, parace participar en la etiopatogenia de la afección, la información disponible en humanos es insuficiente para determinar si ellos son causa o efecto del trastorno. Se requiere aún más investigación para entender mejor la etiología y la patogenia de la enterocolitis necrotizante, a partir de la cual desarrollar métodos de prevención o nuevas opciones para mejorar los resultados del tratamiento de los recién nacidos afectados
Subject(s)
Humans , Enterocolitis, Pseudomembranous/etiology , Infant, Newborn, Diseases , Antibody Formation , Enterocolitis, Pseudomembranous/immunology , Enterocolitis, Pseudomembranous/prevention & control , Platelet Activating Factor , Intestines/physiopathology , Risk FactorsABSTRACT
El prognóstico del Tumor de Wilms ha mejorado notablemente al agregar a la cirugía quimioterapia y radioterapia agresivas. Se analizan 24 casos de Tumor de Wilms tratados en el Hospital Roberto del Río entre 1978 y 1989. 14 eran mujeres y 10 hombres. El promedio de edad fue 3 años y 7 de ellos eran menores de 1 año. El signo clínico más frecuente fue aumento de volumen abdominal; en un tercio de los casos este hallazgo fue hecho por la madre o en un examen de salud (control de niño sano). En todos los niños se realizó nefrectomía y quimioterapia. En 3, además se hizo Q.T. preoperatoria y en 6 radioterapia además de cirugía y quimioterapia. La sobrevida, (tiempo de observación de 8 meses a 12 años con una mediana de 3 años) fue de 71%
