ABSTRACT
STUDY OBJECTIVE: To determine whether clinical variables accurately identify children with radiographically proven constipation. METHODS: Prospective, cross sectional case series of children 2-12 years of age with abdominal pain (AP) requiring radiographic evaluation. Constipation was defined radiographically as the presence of fecal material throughout the colon. The presence of other pathology was noted. The pediatric emergency department (ED) physicians recorded a comprehensive history and physical examination and a provisional diagnosis was made. Radiographs were initially interpreted by the pediatric ED attending physicians; the official interpretation was later provided by a single board certified pediatric radiologist who was blinded to the ED interpretation. A discriminant analysis was performed to identify variables that could best discriminate between patients with, and without, radiographically proven constipation. RESULTS: In total 251 patients were enrolled over a 12 month period. Four variables were noted to be more common in constipated patients: a history of normal or hard stools, absence of rebound tenderness, presence of tenderness in the left lower quadrant and stool in the rectal vault on exam. Stool present on rectal exam was the best discriminator between patients with and without constipation. The discriminant analysis model had a sensitivity of 77%, specificity of 35% and a negative predictive value of 55%. CONCLUSION: No clinical variable, either as a single variable or in a model, accurately identified patients with abdominal pain and radiographically proven constipation.
Subject(s)
Constipation/diagnosis , Physical Examination , Child , Child, Preschool , Cross-Sectional Studies , Discriminant Analysis , Female , Humans , Male , Prospective Studies , Sensitivity and SpecificityABSTRACT
Eighty-one pediatric patients had nuclear bone-imaging studies confirmatory of osteomyelitis during the past 10 years. Seven (8.6%) of 81 had "cold" osteomyelitis. These seven patients were all toxic [mean temperature (T), 39.9 degrees C; heart rate (HR), 145 beats/min], all had markedly elevated erythrocyte sedimentation rates (mean ESR, 76 mm/h), and six of seven had both confirmatory bone and blood cultures. All patients required surgical intervention. The average length of hospital stay for these seven patients was 32 days (range, 8-65 days). A control group of matched patients with "hot" osteomyelitis was constructed for statistical evaluation. This analysis confirmed significantly increased temperature, resting pulse rate, ESR, length of hospital stay, and rate of surgical intervention in patients with cold versus hot osteomyelitis. Patients with osteomyelitis presenting as a cold defect on bone imaging appeared to have a more aggressive type of bone infection, often requiring aggressive medical and surgical intervention adequately to control this infectious process.
Subject(s)
Bone and Bones/diagnostic imaging , Haemophilus Infections/diagnosis , Osteomyelitis/diagnostic imaging , Staphylococcal Infections/diagnosis , Case-Control Studies , Child , Child, Preschool , Female , Haemophilus Infections/therapy , Humans , Length of Stay , Male , Osteomyelitis/therapy , Prognosis , Radionuclide Imaging , Reference Values , Retrospective Studies , Sensitivity and Specificity , Staphylococcal Infections/therapy , WisconsinSubject(s)
Myositis/etiology , Proteus mirabilis/isolation & purification , Adolescent , Humans , Male , Myositis/diagnosis , SwimmingABSTRACT
An 11 year old Chinese boy developed a unilateral cervical mass associated with pronounced eosinophilia and a marked increase in IgE concentrations. A biopsy sample showed massive eosinophilic tissue infiltration consistent with Kimura's disease. This disorder should be suspected when the clinical triad of painless unilateral cervical adenopathy, hypereosinophilia, and hyper-IgE is present, particularly in male Asian patients.
Subject(s)
Angiolymphoid Hyperplasia with Eosinophilia/complications , Immunoglobulin E/blood , Lymphatic Diseases/etiology , Angiolymphoid Hyperplasia with Eosinophilia/immunology , Asia/ethnology , Child , Humans , Lymphatic Diseases/immunology , Male , NeckSubject(s)
Brain Neoplasms/diagnosis , Neoplasm Recurrence, Local/surgery , Rhabdoid Tumor/diagnosis , Brain Neoplasms/physiopathology , Brain Neoplasms/surgery , Chemotherapy, Adjuvant , Follow-Up Studies , Humans , Infant , Male , Reoperation , Rhabdoid Tumor/physiopathology , Rhabdoid Tumor/surgery , Tomography, X-Ray ComputedSubject(s)
Hip Dislocation/diagnostic imaging , Muscle, Skeletal/diagnostic imaging , Abnormalities, Multiple , Cleft Palate/pathology , Face/abnormalities , Humans , Hypertelorism/pathology , Joint Dislocations/pathology , Joint Instability/pathology , Magnetic Resonance Imaging , Radionuclide Imaging , Recurrence , SyndromeSubject(s)
Bone Neoplasms/secondary , Brain Neoplasms/secondary , Kidney Neoplasms/pathology , Wilms Tumor/secondary , Bone Neoplasms/diagnostic imaging , Brain Neoplasms/diagnostic imaging , Child , Humans , Male , Parietal Bone/diagnostic imaging , Radionuclide Imaging , Wilms Tumor/diagnostic imagingABSTRACT
A wire stent was used successfully to treat life-threatening tracheomalacia in a 5-year-old girl. Wire stents placed bronchoscopically are nonobstructing and have the potential for balloon expansion to accommodate growth.
Subject(s)
Stents , Tracheal Diseases/therapy , Bronchoscopy , Child, Preschool , Chromosome Deletion , Chromosomes, Human, Pair 7 , Female , Humans , Trachea , Tracheal Diseases/diagnosisSubject(s)
Aortic Aneurysm, Abdominal/etiology , Aortic Aneurysm, Thoracic/etiology , Aortic Dissection/etiology , Marfan Syndrome/diagnosis , Aortic Dissection/diagnosis , Aortic Dissection/surgery , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/surgery , Child, Preschool , Female , Humans , Marfan Syndrome/complicationsSubject(s)
Granuloma, Plasma Cell/diagnosis , Urinary Bladder Diseases/diagnosis , Child , Diagnosis, Differential , Granuloma, Plasma Cell/complications , Granuloma, Plasma Cell/surgery , Hematuria/etiology , Humans , Male , Tomography, X-Ray Computed , Urinary Bladder Diseases/complications , Urinary Bladder Diseases/surgery , Urinary Bladder Neoplasms/diagnosisABSTRACT
A 13-month-old patient with autoimmune deficiency syndrome had renal candidiasis. An abnormal renal sonographic pattern of hyperechoic renal pyramids was demonstrated. This abnormal sonographic finding should suggest renal candidiasis in an immune suppressed child. In the normal kidney of children, the pyramids are hypoechoic. This pattern has not been noted in previous publications. We report this case.
Subject(s)
AIDS-Associated Nephropathy/diagnostic imaging , AIDS-Related Opportunistic Infections/diagnostic imaging , Candidiasis/diagnostic imaging , Kidney/diagnostic imaging , Humans , Infant , Male , UltrasonographySubject(s)
Bone and Bones/diagnostic imaging , Child Abuse/diagnosis , Hematoma/diagnostic imaging , Liver Diseases/diagnostic imaging , Soft Tissue Injuries/diagnostic imaging , Child, Preschool , Female , Fractures, Bone/diagnostic imaging , Hematoma/etiology , Humans , Liver Diseases/etiology , Radionuclide ImagingABSTRACT
Hemolytic uremic syndrome is characterized by an abrupt onset of a microangiopathy, thrombocytopenia, hemolytic anemia and renal failure. These abnormalities present in varying degrees. The vascular abnormalities include endothelial swelling and thrombus formation. The kidney is the major target of involvement, although intestines, lung and brain may also be affected. It is considered a disease of the infant, although it occurs in older children and adults as a component of thrombotic thrombocytopenic purpura. We present the sonographic findings of adrenal involvement in a child with hemolytic uremic syndrome, which seems to be a rare occurrence. The patient developed adrenal insufficiency during the acute phase of the disease.
