Tethered Cord Syndrome: Role of Imaging Findings in Surgical Decision-Making.

For infants presenting with urinary problems or lower extremity weakness, imaging is ordered to investigate spinal pathology. Tethered cord syndrome (TCS) often manifests without conclusive anatomic evidence. In our case, a premature infant presented with urosepsis and was found to have an asymmetric gluteal crease and a sacral dimple. Renal ultrasound showed mild hydronephrosis, and a cystourethrogram revealed bilateral high-grade vesicoureteral reflux. Ultrasound and magnetic resonance imaging demonstrated a borderline low-lying spinal cord at the mid-L3 vertebral level. Urodynamic testing to confirm neurogenic bladder could not be completed on the first attempt due to urinary tract infection and on the second attempt due to instrument intolerance. Despite the lack of conclusive imaging evidence of a tethered cord, enough supportive clinical data was present to proceed with surgical intervention with the goal of preventing the progression of neurological dysfunction. Because TCS is ultimately a clinical diagnosis, appropriate management should not be discouraged by inconclusive or borderline imaging findings.

Pediatric hyperparathyroidism and ossification of the ligamentum flavum: A case report.

Hyperparathyroidism (HPT) is a rare endocrine disorder in the pediatric population. Patients often present with bone pain and abnormal gait along with biochemical findings of hypercalcemia, hypophosphatemia, and elevated parathyroid hormone (PTH). HPT is most commonly due to the unregulated secretion of PTH from a parathyroid adenoma. Diagnosis is usually identified with sonography and scintigraphy to localize parathyroid anomalies. Treatment traditionally involves parathyroidectomy with postoperative monitoring of serum calcium and phosphate levels. Here we present a case of a preadolescent girl with metabolic bone disease secondary to hyperparathyroidism.

Calcified encapsulating peritoneal sclerosis associated with peritoneal dialysis: A case report.

Encapsulating peritoneal sclerosis (EPS) is a rare, but sometimes fatal, complication of peritoneal dialysis characterized by diffuse thickening and encapsulation of the bowel and peritoneum. In more advanced cases, the peritoneum will gradually calcify. EPS usually presents as partial small bowel obstruction and diagnosed on imaging studies. We present a case of a 19-year-old female on long-term peritoneal dialysis with EPS and diffuse peritoneal calcifications.

Endobronchial mucoepidermoid carcinoma in a pediatric patient: A case report.

Mucoepidermoid carcinoma (MEC) is an uncommon type of salivary gland tumor that can present as an endobronchial neoplasm, most commonly in the adult population. Neuroendocrine carcinoid tumors comprise the majority of bronchial neoplasms in the pediatric population and are nearly indistinguishable from MEC on imaging. We present a rare case of MEC in a 3-year-old presenting with recurrent symptoms of lower airway obstruction and discuss its typical associated symptoms and imaging features.

Cystic dysplasia of the rete testis associated with ipsilateral renal agenesis: A case report.

Cystic dysplasia of the rete testis is a rare benign abnormality seen in the pediatric population. Diagnosed by scrotal ultrasonography, this lesion is often associated with congenital renal tract anomalies, most commonly ipsilateral renal agenesis or multicystic dysplastic kidney. Treatment traditionally involves orchiectomy or testicular sparing surgery; however, conservative treatment with surveillance has been used as an appropriate alternative. We present the case of a 5-year-old boy with cystic dysplasia of the rete testis with associated unilateral renal agenesis.

Fibrolipomatous hamartoma of the foot with associated macrosyndactyly: a case report.

Fibrolipomatous hamartoma is a rare benign congenital overgrowth of fibroadipose tissue in the nerve sheath. While usually affecting the median nerve, the digits of the hands and feet are sometimes affected and may result in macrodactyly, which is referred to as macrodystrophia lipomatosa. We present a rare case of fibrolipomatous hamartoma in a 6-week-old female's foot with macrodactyly and syndactyly and discuss its presentation and radiologic features.

Infantile Adenomyomatosis of the Gallbladder in a 3-Month-Old.

Adenomyomatosis of the gallbladder is an acquired condition of the gallbladder with epithelial, mucosal, and muscular hypertrophy. The result is usually gallbladder wall thickening with associated diverticula known as Rokitansky-Aschoff's sinuses. These mucosal invaginations of the gallbladder wall may extend beyond the muscular layer. The condition is typically asymptomatic and is predominantly diagnosed in adults between 50 and 60 years of age, usually with concomitant cholelithiasis, motility disorders, or chronic inflammation. Few cases within the literature have been described in the pediatric population and even fewer within this subset have been diagnosed in infants. We describe a case of a 3-month-old male with failure to thrive, persistent nonbilious, nonbloody emesis, and elevated transaminases with ultrasound evidence of gallbladder adenomyomatosis. The patient was managed with outpatient laboratory monitoring and follow-up imaging.

Rib head dislocation causing spinal canal stenosis in a child with neurofibromatosis, type 1.

A 10-year-old female with neurofibromatosis type 1 and severe dystrophic scoliosis presented with a two-month history of difficulty ambulating due to low back pain. The patient did not have any neurological symptoms. MRI of the thoracolumbar spine demonstrated subluxation of the right posterior tenth and eleventh ribs through their respective neural foramina, with mild mass effect on the thecal sac without abnormal cord signal or cord compression. Groups of neurofibromas were present along the right ribs and paravertebral soft tissues around these levels. CT evaluation was completed for greater osseous definition. Cases of rib head dislocation into the central canal in the setting of dystrophic scoliosis were documented in only a limited sample of case reports. The angulated short-segment curvature in dystrophic scoliosis causes vertebral body rotation, foraminal enlargement, spindling of transverse processes, and penciling of the apical ribs. These changes can alter the articulation of the rib along the transverse process. The enlarged foramina can also create a larger space into which a rib may displace. As a result, in most reported cases, the subluxed ribs were on the convex apex of the curve in the mid-to-lower thoracic region. The risk of cord injury from rib head dislocation makes the complete depiction of the anatomy essential for proper surgical management.

The simple sacral dimple: diagnostic yield of ultrasound in neonates.

BACKGROUND: Although spinal cord tethering is known to be associated with certain clinical syndromes and cutaneous stigmata, its incidence in healthy infants with simple sacral dimples has not been thoroughly evaluated. OBJECTIVE: Our objective was to determine the frequency of tethered cord in otherwise healthy patients with simple sacral dimples. MATERIALS AND METHODS: We reviewed the lumbar spine US reports of all healthy neonates referred for a simple sacral dimple during a 12-year period at two children's hospitals. A sonogram was considered abnormal for a conus medullaris terminating below the L2-L3 disc space, decreased conus or nerve root motion, an abnormal filum terminale, or for the presence of an intraspinal mass, osseous dysraphism, or a sinus leading to the thecal sac. The medical records of patients with abnormal screening sonograms were reviewed to determine the final clinical outcome. RESULTS: During the study period 3,991 infants underwent screening sonography. Of these, 107 were excluded because of the presence of other medical conditions. Of the remaining 3,884 healthy infants, 133 (3.4%) had an abnormal sonogram. Five (0.13%) of these infants were lost to follow-up; 52 subsequently had normal follow-up imaging; 49 had a low conus without other signs of tethering; 18 had a fatty filum; 2 had decreased conus motion; 2 had both a low conus and a fatty filum. None of these infants underwent surgery. Only the remaining 5/3,884 (0.13%) infants underwent surgical intervention (95% CI: 0-0.27%), and 4/5 were found to have a tethered cord intraoperatively. CONCLUSION: The risk of significant spinal malformations in asymptomatic, healthy infants with an isolated simple sacral dimple is exceedingly low.

Native soil fungi associated with compostable plastics in three contrasting agricultural settings.

Plastics are used widely as agricultural mulches to suppress weeds and retain soil moisture. Disposal of conventional plastic mulches requires physical removal for disposal in a landfill or incineration. Biodegradable plastic mulches that could be tilled into the soil at the end of a growing season represent an attractive alternative to conventional plastic mulches. In this study, three commercially available mulches labeled as "biodegradable" and one experimental, potentially biodegradable mulch were used during a tomato growing season, and then buried in field soil at three locations for approximately 6 months, as would occur typically in an agricultural setting. Degradation after 6 months in soil was minimal for all but the cellulosic mulch. After removal of mulches from soil, fungi were isolated from the mulch surfaces and tested for their ability to colonize and degrade the same mulches in pure culture. The majority of culturable soil fungi that colonized biodegradable mulches were within the family Trichocomaceae (which includes beneficial, pathogenic, and mycotoxigenic species of Aspergillus and Penicillium). These isolates were phylogenetically similar to fungi previously reported to degrade both conventional and biodegradable plastics. Under pure culture conditions, only a subset of fungal isolates achieved detectable mulch degradation. No isolate substantially degraded any mulch. Additionally, DNA was extracted from bulk soil surrounding buried mulches and ribosomal DNA was used to assess the soil microbial community. Soil microbial community structure was significantly affected by geographical location, but not by mulch treatments.

Isolation of native soil microorganisms with potential for breaking down biodegradable plastic mulch films used in agriculture.

Fungi native to agricultural soils that colonized commercially available biodegradable mulch (BDM) films were isolated and assessed for potential to degrade plastics. Typically, when formulations of plastics are known and a source of the feedstock is available, powdered plastic can be suspended in agar-based media and degradation determined by visualization of clearing zones. However, this approach poorly mimics in situ degradation of BDMs. First, BDMs are not dispersed as small particles throughout the soil matrix. Secondly, BDMs are not sold commercially as pure polymers, but rather as films containing additives (e.g. fillers, plasticizers and dyes) that may affect microbial growth. The procedures described herein were used for isolates acquired from soil-buried mulch films. Fungal isolates acquired from excavated BDMs were tested individually for growth on pieces of new, disinfested BDMs laid atop defined medium containing no carbon source except agar. Isolates that grew on BDMs were further tested in liquid medium where BDMs were the sole added carbon source. After approximately ten weeks, fungal colonization and BDM degradation were assessed by scanning electron microscopy. Isolates were identified via analysis of ribosomal RNA gene sequences. This report describes methods for fungal isolation, but bacteria also were isolated using these methods by substituting media appropriate for bacteria. Our methodology should prove useful for studies investigating breakdown of intact plastic films or products for which plastic feedstocks are either unknown or not available. However our approach does not provide a quantitative method for comparing rates of BDM degradation.

Cystic lesions of the pancreas: radiologic-endosonographic correlation.

Cystic lesions of the pancreas are relatively common findings at cross-sectional imaging; however, classification of these lesions on the basis of imaging features alone can sometimes be difficult. Complementary evaluation with endoscopic ultrasonography and fine-needle aspiration may be helpful in the diagnosis of these lesions. Cystic lesions of the pancreas may range from benign to malignant and include both primary cystic lesions of the pancreas (including intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, serous cystadenomas, pseudocysts, and true epithelial cysts) and solid neoplasms undergoing cystic degeneration (including neuroendocrine tumors, solid pseudopapillary neoplasms, and, rarely, adenocarcinoma and its variants). Familiarity with the imaging features of these lesions and the basic treatment algorithms is essential for radiologists, as collaboration with gastroenterologists and surgeons is often necessary to obtain an early and accurate diagnosis.

Effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections.

BACKGROUND: Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs). DESIGN: Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts. SETTING: Academic medical center. PATIENTS: All patients except neonates and infants. INTERVENTION AND MEASUREMENTS: CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured. RESULTS: Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90%) was better than that observed in other units (57.7%, [Formula: see text]). A significant decrease in infections due to Clostridium difficile was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95% confidence interval [CI], 0.57-0.89; [Formula: see text]) for 3-days-per-week CHG bathing and 0.41 (95% CI, 0.29-0.59; [Formula: see text]) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95% CI, 1.38-2.53; [Formula: see text]), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported. CONCLUSIONS: CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized patients.

Ruptured intracranial dermoid cyst manifesting as new onset seizure: a case report.

Intracranial dermoid cysts are rare tumors derived from ectopic epithelial cells. They are slow-growing benign entities, but can cause significant morbidity through compression of neurovascular structures and, rarely, rupture into the subarachnoid space. We present a rare case of a spontaneously ruptured intracranial dermoid cyst presenting as new onset seizures due to chemical meningitis caused by dissemination of fat droplets.

PLFA profiling of microbial community structure and seasonal shifts in soils of a Douglas-fir chronosequence.

The impact and frequency of forest harvesting could significantly affect soil microbial community (SMC) structure and functioning. The ability of soil microorganisms to perform biogeochemical processes is critical for sustaining forest productivity and has a direct impact on decomposition dynamics and carbon storage potential. The Wind River Canopy Crane Research Forest in SW, WA, provided a unique opportunity to study a forest chronosequence and the residual effects of harvesting on the SMC in comparison to old-growth forests. The objective of this study was to determine the effect of clear-cutting and stand age on temporal dynamics of SMC and physiological stress markers using phospholipid fatty acid (PLFA) profiling. Soil microbial PLFA profiles were determined seven times over 22 months (Nov. 02 to Sep. 04) in old-growth coniferous forest stands (300-500 years) and 8 (CC8)- or 25 (CC25)-year-old replanted clear-cuts. PLFA patterns of the SMC shifted because of clear-cutting, but seasonal temporal changes had greater shifts than differences among stand age. The microbial biomass (total PLFA) and bacterial, fungal, and selected other PLFAs were significantly reduced in CC8 but not in CC25 sites relative to the old-growth sites. An increase in stress indicators [PLFA ratios of saturated/monsaturated and (cy17:0 + cy19:0)/(16:1omega7 + 18:1omega7)] in late summer was related to water stress. Although the canopy and litter input are quite different for a 25-year clear-cut compared to virgin old-growth forest, we conclude that the composition of the microbial communities, 25 years after clear-cutting, has recovered sufficiently to be much more similar to old-growth forests than a recent clear-cut at this Pacific Northwest forest site. The study shows the potential of PLFA analysis for profiling microbial communities and their stress status under field conditions, but wide temporal shifts emphasize the need for sampling over seasons to fully interpret ecosystem management impacts on microbial populations.