Who are we missing? Too few skeletal surveys for children with humeral and femoral fractures.

AIM: To determine the potential shortfall in skeletal survey referral for children presenting with an acute non-supracondylar humeral or femoral fracture. MATERIALS AND METHODS: Plain radiograph reports were reviewed retrospectively using the radiology information system database over a 5 year study period (May 2008-2013) in children under 18 months of age who presented with an acute fracture. Subsequent skeletal survey referral was used as a surrogate marker for further investigation of child abuse. Application of robust meta-analysis derived probability data regarding likelihood of child abuse as a cause of non-supracondylar humeral or femoral fracture was applied. An estimation of the expected number of cases of abuse, with shortfall in skeletal survey referrals, was then calculated. RESULTS: There were 288 fractures in 281 children. Three children presented with multiple fractures and were considered separately in the present data. The mean patient age was 10.5 months. Nine (3%) non-supracondylar humeral fractures were identified of which four cases may have been due to non-accidental injury (NAI). One (11%) of these patients was referred for a skeletal survey indicating a potential shortfall of three referrals. Twenty-five (9%) femoral fractures were identified of which 13 cases may have been due to NAI, with six (24%) referrals for skeletal surveys generated. This indicates a potential shortfall of seven referrals. CONCLUSION: The present study serves as a current analysis of practice within a tertiary paediatric referral centre. There appeared to be local under-investigation of NAI. Improved child protection education and awareness programmes have now been introduced.

Evaluation of the upper urinary tract using transureteric ultrasound--a review of the technique and typical imaging appearances.

Ureteric strictures and pelviureteric junction obstruction often present a diagnostic conundrum to radiologists, particularly after the first-line investigations have failed to provide a definitive answer. Transureteric ultrasonography (TUU) is a relatively novel technique performed by the radiologist, which uses a miniature endoluminal ultrasound probe to interrogate the ureteric anatomy and peri-ureteric soft tissues. In this review, we discuss how TUU is performed, and the normal imaging appearances of the ureter and surrounding anatomical structures. We also focus on the various pathological processes that can be accurately evaluated or diagnosed using TUU including lymphadenopathy, calculi, ureteric neoplasms, ureteritis, crossing vessels and aneurysms. As TUU is not well established in UK practice as yet, we suggest possible indications for its use in the diagnostic work-up of urological patients and future applications.

Pressure-dependent diffusion coefficients and haven ratios in cation-conducting glasses.

The influence of hydrostatic pressure on diffusion and ionic conduction is providing deeper insights into the atomistic mechanisms of ionic motion in glasses. We have studied the tracer diffusion of 22Na in a sodium borate glass and of 86Rb in a rubidium borate glass as functions of hydrostatic pressures. The activation volumes of tracer diffusion are DeltaVD(Rb) = 33.5 cm3 mol-1 and DeltaVD(Na) = 6.1 cm3 mol-1. In comparison, the activation volumes of charge diffusion obtained recently from the pressure dependence of conductivity are smaller: DeltaVsigma(Rb) = 7.2 cm3 mol(-1) and DeltaVsigma(Na) = 2.8 cm3 mol(-1). These differences, where (DeltaVD - DeltaVsigma) > 0, imply that the Haven ratios decrease with pressure. This effect is particularly significant for the rubidium borate glass. Starting from basic equations of linear response theory for mass and charge transport, we develop a model that accounts for these experimental findings. The difference between the activation volumes, DeltaVD and DeltaVsigma, and the pressure-dependent Haven ratios are consequences of collective movements of ions in glass, implying a concerted motion of ions in a chain- or caterpillar-like fashion. In our treatment, it is a vacant site (with ions jumping into it successively) that moves along an extended pathway. Hence, we regard vacant sites as the carriers of charge and ions as the carriers of diffusing matter. The decrease of the Haven ratio with pressure is attributed to the influence of pressure on the topology of the conduction pathways, which are progressively straightened out with increasing pressure.

Cardiovascular and electroencephalographic effects of laudanosine in "nephrectomized" cats.

We studied a cat model simulating laudanosine accumulation in the "anephric" patient. Cardiovascular effects were seen only with the bolus doses of laudanosine 2 mg kg-1, and at plasma laudanosine concentrations unlikely to be achieved clinically. Similarly, EEG and power spectra analysis showed no evidence of epileptiform activity at all plasma laudanosine concentrations achieved. The non-specific EEG/power spectra changes observed may reflect a direct CNS activity with neurodepression, since laudanosine was shown by its presence in CSF to cross the blood-brain barrier. These EEG changes were observed at plasma concentrations eight to 10 times those observed in humans during infusion of atracurium. Thus, laudanosine accumulation and related CNS or cardiovascular toxicity seem unlikely following atracurium administration in the anephric patient.