Carbapenem-resistant Enterobacteriaceae rectal screening during an outbreak of New Delhi metallo-ß-lactamase-producing Klebsiella pneumoniae at an acute care hospital.

We describe the results of carbapenem-resistant Enterobacteriaceae (CRE) screening as part of an outbreak investigation of New Delhi metallo-ß-lactamase-producing CRE at a tertiary care university teaching hospital. The manual method for CRE screening was useful for detecting patients with asymptomatic CRE carriage but was time-consuming and costly.

Evaluation and treatment of chemotherapy extravasation injuries.

Extravasation of chemotherapeutic vesicant agents can result in significant tissue damage, alteration in limb function, and pain. Quality of life for long-term survivors can be severely impacted by negative sequelae from vesicant extravasation. Currently, there is no known preventive therapy. Early detection and intervention are paramount to halt tissue damage and reduce the chance of permanent disability or disfigurement. This article provides an overview of known chemotherapeutic vesicants (mechlorethamine, mitomycin-C, doxorubicin, daunomycin, vincristine and vinblastine), associated theories of tissue destruction, assessment techniques for peripheral intravenous sites, vascular access devices and central venous lines, current treatment strategies, and investigational therapies. A brief discussion of the legal implications of extravasation injuries and recommended key points for medical record documentation are included.

Ex vivo intracystic contrast studies of multicystic dysplastic kidneys.

PURPOSE: Classically cysts in multicystic dysplastic kidneys are described as noncommunicating. We determined the accuracy of this hypothesis by performing ex vivo intracystic contrast studies of the typical multicystic kidney and hydronephrotic form of the multicystic kidney. MATERIALS AND METHODS: We evaluated 7 multicystic dysplastic kidneys in patients between 2 weeks and 6 months old using intracystic injection of contrast material, including 4 that were typical and 3 with the hydronephrotic form of multicystic disease. Six and 1 kidneys were evaluated ex vivo and percutaneously, respectively. We obtained images during injection and shortly thereafter. RESULTS: When contrast material was injected into 1 cyst, it was eventually seen in most of the other cysts in all 7 kidneys. In 6 kidneys discrete ducts were clearly visualized between the cysts. In the hydronephrotic form of the disease these ducts connected to a pelvis-like structure. When evaluated grossly and the cysts were unroofed, a small orifice was noted in each cyst that sometimes admitted a 3.5F feeding tube. CONCLUSIONS: It is generally thought that multicystic kidneys represent a condition with noncommunicating cysts. We believe that the cysts in most multicystic kidneys communicate whether or not a renal pelvis is present.

Infant botulism: a rare cause of colonic ileus.

We have recently seen two patients with infant botulism, one of whom had radiologic evidence of autonomic and neuromuscular dysfunction. Both infants had been fed small amounts of honey, which is often contaminated with Clostridium botulinum spores, during the Jewish New Year celebration.

Unilateral multicystic dysplasia in 1 component of a horseshoe kidney: case reports and review of the literature.

We report on 3 pediatric patients with multicystic dysplasia involving 1 component of a horseshoe kidney. Including our cases, 18 cases of unilateral multicystic dysplasia in a horseshoe kidney have been reported. The clinical, radiological and pathological features of these cases are briefly reviewed. The association of multicystic dysplastic kidney and horseshoe kidney presents a unique diagnostic challenge. Because of the rarity of unilateral multicystic dysplasia in a horseshoe kidney and the size of the dysplastic component, which crossed the midline in our patients, we chose to excise that component. Cross-sectional imaging techniques, that is computerized tomography and magnetic resonance imaging, were helpful in diagnosis and in planning operative treatment.

The Older Americans Act: should participants share in the cost of services?

Since its inception in 1965, the Older Americans Act has provided social services free of charge to older people, regardless of income. In recent years, the scarcity of resources has sparked a debate as to whether participants who can afford to pay for services should be required to do so. Of concern is whether charging fees will change the fundamental nature of these popular programs by imparting a "welfare" stigma. Other programs that require fees vary enormously by state, and there has been little documentation of their impact on participation, equity of service delivery, or public attitudes. In order to evaluate current proposals, it is necessary to analyze the distributional effects of the cost-sharing system, how the program will be administered, what impact it will have on service use, which services would be subject to cost sharing and at what income levels, and what constitutes a "reasonable" fee for service.

Drug-related complications in infants and children: imaging features.

Iatrogenic disorders continue to be an important cause of morbidity and mortality in infants and children. Most adverse drug reactions have no distinctive radiologic features. Of those with radiologic manifestations, it is usually impossible to differentiate iatrogenic disorders from their spontaneously occurring counterparts. However, certain iatrogenic disorders have distinctive imaging characteristics that allow their recognition in specific patient populations. This review considers a variety of drug-related disorders and phenomena that have been the subject of original articles in the English language literature since 1984.

Triphalangeal thumb.

Triphalangeal thumb (TPT), a rare malformation of uncertain pathogenesis, may occur as an isolated defect, in association with other malformations of the hands, or as a feature of a syndrome or sequence. Isolated TPT occurs in two functional types: opposable and non-opposable. The latter appears to be inherited as a simple autosomal dominant trait, while the former is generally sporadic. TPT is associated with a number of specific malformations of the hand or foot, several of which have a well documented autosomal dominant pattern of inheritance. TPT is a feature of a number of specific syndromes. In this setting it may be associated with radial hypoplasia, bone marrow dysfunction, congenital heart disease, lung hypoplasia or agenesis, anorectal malformations, sensorineural hearing loss, onychodystrophy, mental retardation, and other disorders. TPT serves as a useful marker in such patients; in conjunction with the clinical and radiological findings, it can help to establish the correct diagnosis, leading to appropriate management and genetic counselling.

Cohen ureteral reimplantation: sonographic appearance.

The sonographic records of 27 children who underwent a Cohen ureteroneocystostomy were reviewed. In 13 children (48%) sonograms demonstrated an echogenic, nonacoustically shadowing structure at or just above the trigone that was fixed in position within the bladder wall and covered by intact mucosa. This constellation of sonographic findings, which represent the submucosal segment of the reimplanted ureter, produces a "tunnel sign." Awareness of this appearance will enable the sonographer to better evaluate children who have undergone surgical procedures on the bladder.

MR and CT demonstration of levator sling in congenital anorectal anomalies.

Demonstration of the levator ani muscle is important in evaluating children with anorectal anomalies. Using magnetic resonance and CT we have imaged the levator sling in three children prior to their definitive surgery for imperforate anus. The levator mechanism was seen as a low signal band extending from the coccyx to the pubis.

Pulmonary candidiasis in infants: clinical, radiologic, and pathologic features.

Although systemic candidiasis is common in hospitalized patients, invasive pulmonary candidiasis is rare and generally considered of secondary importance when found at autopsy. Autopsy records for a 12 year period were reviewed and 15 infants were found in whom systemic candidiasis was considered the primary or a major contributory cause of death. Significant pulmonary involvement was found in 14. There were three characteristic histologic patterns of pulmonary candidiasis: (1) embolic (arterial-invasive) (seven cases); (2) disseminated (capillary-invasive) (four cases); and (3) bronchopulmonary (air space-invasive) (three cases, including one congenital infection). An indwelling vascular catheter or infected cutdown wound was the portal of entry in every case of the embolic form of pulmonary candidiasis. Systemic and pulmonary Candida infections were rarely diagnosed during life. The typical radiographic appearance was progressive air space consolidation, although two infants with the embolic form of pulmonary candidiasis had focal cavitation. In general, there was poor correlation between the radiologic and pathologic findings, and pathologic findings other than pulmonary candidiasis undoubtedly accounted for many of the radiologic abnormalities observed. There were no radiologic findings that could be used to differentiate the three histologic forms of lung involvement in these patients. Small lung nodules, the earliest histologic lesion of pulmonary candidiasis, were not seen in any patient owing to the presence of other lung disease and suboptimal radiographic technique.

Bilateral kidney herniation: complication of cutaneous pyelostomy.

A case of bilateral kidney herniation through cutaneous pyelostomy stomas is reported. The child is doing well after successful closure of the pyelostomies and repair of both ureteropelvic junctions obstructions.

Sonographic evaluation of the chest in infants and children.

Sonography was used to evaluate 28 patients (age range, newborn to 16 years) with mediastinal and juxtacardiac masses and disease processes, partial or complete opacification of a hemithorax, and various juxtadiaphragmatic abnormalities. Technically adequate studies were obtained in 93% of the cases. Sonography was of greatest value in determining the cause of an opaque hemithorax, characterizing fluid collections, localizing fluid collections prior to percutaneous aspiration or drainage, and demonstrating the position and integrity of the diaphragm. Sonography was least successful in depicting and characterizing mediastinal disorders. The authors' method is described and the technical limitations and pitfalls of pediatric chest sonography are discussed.

Nephrocalcinosis in chronic glomerulonephritis: report of the youngest patient.

Diffuse cortical calcification is an unusual form of nephrocalcinosis most often seen in chronic glomerulonephritis (CGN). The authors report the youngest patient with nephrocalcinosis of CGN, a 13-year-old boy, and briefly review the radiologic and pathologic features of this entity.

The radiographic approach to injuries of the prostatomembranous urethra in children.

We favor initial non-operative treatment (suprapubic cystostomy drainage only) for prostatomenbranous urethral injuries in children and adolescents. Non-operative treatment usually results in uncomplicated strictures that can be corrected by a 1-stage transperineal or transpublic operation 4 to 6 months later. A hands-off diagnostic approach, which relies on excretory urography and retrograde injection urethrography to demonstrate partial and complete tears, eliminates the need for blind passage of catheters, an invasive procedure that may lead to complicated strictures unsuitable for a 1-stage repair. If a 1-stage repair is planned it is necessary to determine the length of the stricture, whether there are local complications and whether the anterior urethra can be widely mobilized. The radiographic techniques used to plan a corrective operation and to evaluate the results are described.

Therapy of osteogenesis imperfecta with synthetic salmon calcitonin.

We evaluated the long-term use of synthetic salmon calcitonin in the management of osteogenesis imperfecta tarda and congenita. Forty-eight children, ranging in age from 6 months to 15 years, and two young adults, received synthetic salmon calcitonin 2 MRC units/kg three days a week and a daily oral calcium supplement of 230 to 345 mg. The annual fracture rate was decreased during calcitonin therapy as compared to the period preceding therapy. There was an increase in the ability of the patient to stand and move and in the subjective feeling of strength in the lower extremities during calcitonin therapy. There was also a significant improvement in radiographic bone density, as determined by the method of photodensitometry, in patients under 5 years of age. Long-term administration of synthetic salmon calcitonin may be beneficial to young children with osteogenesis imperfecta.