ABSTRACT
The present article reviews the scientific evidence available on diagnostic imaging tests in urinary tract infections in childhood. There is sufficient information on the technical validity of the various imaging tests. Through calculating probabilities, this information can be used in the process of diagnostic decision making. Nevertheless, the diagnostic yield offered by these tests is unclear; some of the estimations of costs, efficacy and risks suggest that certain diagnoses have little clinical importance. The current strategy of routine use of imaging tests should probably be replaced by an individually-tailored approach, in which tests are indicated by taking into account the information available at each stage of the process, patients' and relatives' opinions, and clinicians' judgment on the probability of the diagnoses and the risks and benefits of each test.
Subject(s)
Evidence-Based Medicine , Urinary Tract Infections/diagnosis , Adolescent , Age Factors , Child , Child, Preschool , Cohort Studies , Consensus Development Conferences as Topic , Diagnosis, Differential , Expert Testimony , Female , Humans , Infant , Infant, Newborn , Kidney Diseases/complications , Kidney Diseases/diagnosis , Kidney Diseases/diagnostic imaging , Male , Prognosis , Radionuclide Imaging , Randomized Controlled Trials as Topic , Retrospective Studies , Risk Assessment , Sex Factors , Ultrasonography , Urinary Tract Infections/diagnostic imaging , Urinary Tract Infections/etiology , Urography , Vesico-Ureteral Reflux/complications , Vesico-Ureteral Reflux/diagnosis , Vesico-Ureteral Reflux/diagnostic imagingABSTRACT
Se presenta una revisión de la evidencia científica disponible sobre las pruebas diagnósticas de imagen en la infección urinaria en la infancia. Contamos con suficiente información sobre la validez técnica de las distintas pruebas de imagen disponibles, que puede ser utilizada, mediante cálculo de probabilidades, en el proceso de toma de decisiones diagnósticas. Con todo, el rendimiento de los diagnósticos que estas pruebas nos ofrecen no está claro; algunas de las estimaciones de costes, eficacia y riesgos nos permiten asumir que ciertos diagnósticos tienen escasa trascendencia clínica. Es probable que la estrategia actual de uso habitual de pruebas de imagen deba ser sustituida por otra personalizada, en la que las pruebas sean indicadas tras considerar la información disponible en cada momento, la opinión de pacientes o familiares y nuestro juicio sobre la verosimilitud de los diagnósticos y los riesgos y beneficios de cada prueba
The present article reviews the scientific evidence available on diagnostic imaging tests in urinary tract infections in childhood. There is sufficient information on the technical validity of the various imaging tests. Through calculating probabilities, this information can be used in the process of diagnostic decision making. Nevertheless, the diagnostic yield offered by these tests is unclear; some of the estimations of costs, efficacy and risks suggest that certain diagnoses have little clinical importance. The current strategy of routine use of imaging tests should probably be replaced by an individually-tailored approach, in which tests are indicated by taking into account the information available at each stage of the process, patients' and relatives' opinions, and clinicians' judgment on the probability of the diagnoses and the risks and benefits of each test
Subject(s)
Male , Female , Child , Humans , Urinary Tract Infections/diagnosis , Diagnostic Imaging/methods , Diagnostic Imaging/trends , Diagnostic Imaging , Evidence-Based Medicine , Urinary Tract Infections , Diagnostic Imaging/classification , Diagnostic Imaging/instrumentationABSTRACT
OBJECTIVE: The aim of this case-control study was to know possible correlates between distinctive pattern of hand arthrosis and length manual milking. PATIENTS AND METHODS: Between January 1990 and January 1996, we retrospectively reviewed the patients with symptomatic arthrosis in whose hands was identified this pattern: degenerative disease of distal interphalangeal joints with radial deviation and flexion of distal phalanges in association to arthrosis involving metacarpophalangeal and interphalangeal joints of the thumb. The first 88 cases of hand arthrosis without this clinical and radiographic pattern make the control group. Patients suffering inflammatory rheumatic diseases were excluded. RESULTS: 35 patients with this special pattern of hand arthrosis were recruited. The majority of patients were women (94.3%) and coming from rural environment (94.3%). 32 patients had performed daily manual milking over a period of 20 years, but in three patients the pattern was not related to this activity (odds ratio = 928: p < 0.001). Symptoms were more frequent in the control-group (57% versus 26%; p < 0.04), in which no characteristic pattern of alignment abnormality was found. CONCLUSION: A typical pattern of hand arthrosis was associated with prolonged manual milking: degenerative disease of metacarpophalangeal and interphalangeal joints of thumb, radial deviation associated with flexion of distal phalanges of second at fourth fingers and arthrosis involving their distal interphalangeal joints, often linked to sight ulnar deviation of middle phalanges.
Subject(s)
Arthritis , Arthropathy, Neurogenic , Dairying , Hand Deformities, Acquired , Occupational Diseases , Aged , Case-Control Studies , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Focal myositis is a rare form of idiopathic inflammatory myopathy. We describe an additional case of focal myositis in a 54-years-old woman presenting as a painful pseudotumor of the left forearm. Muscle enzymes were normal but generalized electromyographic abnormalities were found. We consider that focal myositis is a heterogeneous clinical syndrome, and the cases showing only focal involvement can be different from those that evolve into polymyositis.
Subject(s)
Muscle Neoplasms/diagnosis , Myositis/diagnosis , Diagnosis, Differential , Electromyography , Female , Forearm , Humans , Magnetic Resonance Imaging , Middle Aged , Myositis/physiopathologySubject(s)
Low Back Pain/etiology , Multiple Sclerosis/diagnosis , Sciatica/etiology , Adult , Brain/pathology , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Multiple Sclerosis/cerebrospinal fluid , Multiple Sclerosis/complications , Multiple Sclerosis/pathology , Spinal Diseases/diagnosisABSTRACT
Systemic Lupus Erythematosus (SLE) is among the chronic diseases thought to predispose patients to severe Salmonella infections. However, arthritis and osteomyelitis due to this microorganisms are more frequently seen in patients with sickle-cell disease than SLE. We report two cases of SLE and osteoarticular infections by Salmonella enteritidis: A 36-years old woman with bilateral knee arthritis associated with femoral osteomyelitis and a 22-years-old woman who presented with left knee arthritis.
Subject(s)
Arthritis, Infectious/etiology , Knee Joint , Lupus Erythematosus, Systemic/complications , Salmonella Infections , Salmonella enteritidis , Adult , Arthritis, Infectious/diagnostic imaging , Female , Humans , Knee Joint/diagnostic imaging , Magnetic Resonance Imaging , Osteomyelitis/diagnosis , Osteomyelitis/etiology , Osteonecrosis/diagnosis , Osteonecrosis/etiology , RadiographySubject(s)
Arthritis, Juvenile/complications , Hematuria/etiology , Tuberculosis, Renal/complications , Adolescent , Humans , MaleABSTRACT
We report two members of one family, a 51-year-old man a 16-year-old son, with enlargement of the jaw, palatine taurus, endosteal sclerosis of the neurocranium and symmetrical diaphyseal cortical thickening. On the basis of those typical findings, the diagnosis of recessive endosteal hyperostosis (Van Buchem's disease) was mode. This unusual hereditary sclerosing bone dysplasia is discussed with respect to the clinical and radiological features as well as its distinction from other sclerosing disorders.
Subject(s)
Hyperostosis/diagnosis , Humans , Hyperostosis/genetics , Male , Middle AgedABSTRACT
We present a 28-year-old patient with liquefying idiopathic lobular panniculitis, a variant of the Weber-Christian's disease and intermittent episodes of arthritis in the left foot refractory to sequential treatment with anti-inflammatory drugs, high doses of prednisone, chloroquine, dapsone, colchicine, cyclosporine and methotrexate.
Subject(s)
Panniculitis, Nodular Nonsuppurative , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Arthritis/drug therapy , Arthritis/etiology , Azathioprine/therapeutic use , Diclofenac/analogs & derivatives , Diclofenac/therapeutic use , Drug Resistance , Female , Humans , Panniculitis, Nodular Nonsuppurative/diagnosis , Panniculitis, Nodular Nonsuppurative/drug therapy , Prednisone/therapeutic useSubject(s)
Chondrocalcinosis/pathology , Tendons/pathology , Aged , Aged, 80 and over , Calcinosis , Female , Humans , Pelvis , Tomography, X-Ray ComputedABSTRACT
We describe the case of a 14-year-old patient with fatigability and muscular cramps beginning in the first infancy and started by physical exercise. The clinical record, the increase of creatinine-kinase without clinical or biological signs of inflammation and the electromyographic normality, suggested the presence of this disease, which was confirmed through microscopic studies (optic and electronic) and histochemistry. We review the clinical and biological characteristics, the diagnostic methods for this type of glycogenosis and its differential diagnosis, because we think that the low suspicion levels among the clinicians contribute to the few cases published in the literature.
Subject(s)
Glycogen Storage Disease Type V/diagnosis , Adolescent , Diagnosis, Differential , Humans , MaleSubject(s)
Erythema Induratum/etiology , Tuberculosis, Pulmonary/complications , Adult , Female , Humans , Rheumatoid Factor/bloodABSTRACT
We present a luetic secondarism in a 40-year-old woman starting as symmetric polyarthritis and hepatitis. The latter presence of cutaneous rash, oral aphtae and anemia, as well as the positivity of anticore antibodies (1/160 core pattern) and anti-cardiolipin antibodies initially suggested a connectivopathy. The diagnosis of secondary syphilis was confirmed by the luetic seropositive results (RPR and FTAabs) and the microscopic observation of mobile microorganisms compatible with Treponemas in the exudate obtained by scraping of the cutaneous lesions. The proteiform expressivity of luetic secondarism is stressed, as well as its rare presentation with articular inflammatory manifestations.
Subject(s)
Arthritis/etiology , Hepatitis, Viral, Human/etiology , Syphilis/diagnosis , Adult , Female , Humans , Syphilis/complicationsABSTRACT
We present the case of a 44-year-old male with ankylosing spondylitis and seropositive rheumatoid arthritis whose evolution was complicated by an intestinal necrotizing vasculitis type nodose panarteritis with fatal consequences. We discuss this exceptional association and its clinicopathological characteristics.
