Megacystis-microcolon-intestinal hypoperistalsis syndrome associated with cystic fibrosis and meconium peritonitis in a female neonate 4 days of age - case report and review of the literature.

We present a case of megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) in a four days old female infant who presented with abdominal distension, bilious vomiting, massive hematuria and feeding intolerance which was first interpreted as Prune Belly Syndrome (PBS), referred to our department after iatrogenic gastric and colonic perforation. Berdon syndrome or MMIHS is a rare congenital anomaly characterized by a massive enlarged bladder, distended abdomen, microcolon, functional obstruction of the gastrointestinal tract, and malrotation.

Acute Lymphoblastic Leukemia with Malignant Hypercalcemia: A Case Report.

BACKGROUND Malignant hypercalcemia is a rare finding in the pediatric population, even more rare in hematological malignancies, such as leukemia. CASE REPORT We present a case of a 6-year-old female patient who was diagnosed with acute lymphoblastic leukemia, with secondary hypercalcemia. She started chemotherapy following the IC-BFM ALL2002 protocol with simultaneous calcitonin, diuretics and aggressive hydration for hypercalcemia, and went into complete remission after the induction therapy. After 4 months of chemotherapy, she was diagnosed with relapse associated again with malignant hypercalcemia, and underwent chemotherapy with the relapse protocol. There was no response after the first 2 cycles, so we decided to start her on clofarabine. Due to the severe hypercalcemia and consecutive osteolysis, she developed several bone fractures and needed gypsum immobilization. We started her again on calcitonin, but she developed severe adverse reactions, so we found it necessary to start bisphosphonates, first zoledronic acid intravenously, and afterwards clodronate orally. Consolidation of bone fractures was achieved, but due to prolonged immobilization she developed bedsores, superinfected with Lichtheimia corymbifera. We started posaconazole orally, but she rapidly went into severe sepsis with multiple organ failure. The leukemia showed no response to chemotherapy, progressed rapidly, and the patient died. CONCLUSIONS Malignant hypercalcemia is associated with a poor prognosis in leukemia, and might need a more aggressive therapy.

Fibroadenoma in Axillary Supernumerary Breast in a 17-Year-Old Girl: Case Report.

BACKGROUND: Supernumerary breast or polymastia is a well documented anomaly of the breast, and commonly presents along the embryonic milk line extending between the axilla and groin. However, cases of polymastia have been recorded in the face, vulva, and perineum. The clinical significance of these anomalies include their susceptibility to inflammatory and malignant changes, and their association with other congenital anomalies of the urinary and cardiovascular systems. CASE: In this article we report a case of fibroadenoma that developed in the supernumerary breast of the right axilla in a 17-year-old girl. It is uncommon to find such palpable masses in young patients. Clinical and sonographic examination of both breasts revealed no abnormalities and no lymph nodes were detected in the axillae or the neck. No associated urologic or cardiovascular abnormalities were found, and the histopathological examination of the excisional biopsy samples showed a well-defined, capsulated intracanalicular type of fibroadenoma similar to that of eutopic mammary tissue. SUMMARY AND CONCLUSION: In this report, we describe a rare case of fibroadenoma in an accessory breast in a young woman. There are a fewer than 40 reports in the world about this subject, of which differential diagnoses include: cancer in axillary supernumerary breast, hidradenitis, axillary lymphadenomegaly, lipomas, anexial cutaneous neoplasia, cysts, and phylloides tumor. The combination of clinical examination, ultrasound, and cytology leads to adequate treatment, especially surgical. The diagnosis could be confused because of findings from cytology. In this case, because of the clinical and sonographic findings and multiple differential diagnosis, only the histopathological study was used to confirm the diagnosis. Despite its high sensitivity, cytology has low specificity and could create false positive results. However, atypical lesions can be seen in fibroadenomas, especially in younger patients, pregnant patients, and in patients who use hormonal contraception. Although there are a few reports, our case report is similar to current medical registers and, after surgical treatment, our patient had an excellent prognosis.

The role of ultrasonography in the evaluation of maxillary sinusitis in pediatrics.

UNLABELLED: Sinusitis in children may sometimes present non-specific signs and symptoms. The imaging techniques used for its diagnosis are computed tomography and magnetic resonance imaging, the standard radiography being used less and less. Ultrasonography is seldom mentioned in literature as a diagnosis method of sinusitis. OBJECTIVE: The purpose of this study is to evaluate the value of ultrasonography compared with the standard X-ray in the diagnosis of maxillary sinusitis in children. METHOD: The study was prospectively conducted. The study group included 76 patients who had an ultrasound of the maxillary sinuses. The including criteria were represented by uncontrolled or partially controlled asthma, symptomatology suggesting rhinosinusitis and age over 4. Patients with radiological anomalies of the maxillary sinuses were excluded from the study as well as the patients who were not examined through X-ray and the ultrasonography on the same day. The ultrasound was performed with a pediatric convex transducer with the patient in a sitting position. The ultrasonographic exam evaluated the presence of fluid collection and mucosal thickening within the maxillary sinuses. Signs evaluated by X-ray exam were: total opacity of the maxillary sinus, air-fluid level and mucosal thickening. The Wilcoxon matched-pairs tests was used in order correlate the results obtained through ultrasonography and radiograph. It was considered statistic significant p<0.05. Using the ROC curve the sensitivity and the specificity of the ultrasound compared with the standard radiograph were determined. RESULTS: Based on the excluding criteria a number of 67 patients (35 male) were selected from the study group. The patient's mean age+/-standard deviation was 9 years 2 months+/-3 years 9 months. 134 maxillary sinuses were analyzed ultrasonographically and radiologically. There was a diagnosis agreement between the two techniques in 112 out of 134 sinuses (83.5%). Compared to the standard X-ray, ultrasonography had a 94.9 % sensitivity and a 98.4 % specificity. The error of the ultrasound exam compared to the standard X-ray evaluated in a divided interpretation was low for the normal aspect (1.58%) and for the fluid collection (5.12%), but the error for the thickening of the mucosa was high, over 50% (59.37%). IN CONCLUSION: Ultrasonography may come to represent, on a larger scale, an accessible imaging alternative to the more invasive investigations used in the present in evaluating fluid collections in the maxillary sinus in pediatrics.

The role of ultrasonography in Albendazole treatment of hydatid liver cyst monitoring in children--three case reports.

UNLABELLED: Hydatid liver cyst represents a zoonosis caused by Echinococcus granulosus. The condition has been known for over 2000 years, with endemic spreading areas in sheep-raising regions of the world, including Africa, the Mediterranean region, Middle East, Asia, Australia, South America and New Zealand. OVERVIEW: This paper describes various aspects of Albendazole chemotherapy used in patients with a clear diagnosis of a hydatid hepatic cyst. The diagnosis is relatively easy to formulate, and the imaging evaluation is used for differential diagnosis and for follow-up in treated patients. Ultrasound images presented in this article show the evolution of hydatid hepatic cyst under Albendazole treatment. IN CONCLUSION: hydatid hepatic cyst is a condition in which long therapy with Albendazole has good results in patient with primary disease but also in cases of relapse, and is an important alternative to surgery.

[Askin tumor. Consideration on a case]. / Tumora askin. Consideratii pe marginea unui caz.

The authors present the case of a male patient of 9 years of age admitted for thoracic pain. The clinical evaluation and the imaging exams (chest X-ray, ultrasonography exam of the chest and thoracic computer tomography) reveal a tumor of the thoracic wall. The child was referred to the surgery. It was revealed an invasive tumoral mass of bone origin. At the pathological exam the tumor presented an aspect of Askin tumor. The authors discuss the theoretical aspects correlated with the diagnosis of Askin tumor, based on the presented case.