Inferior vena cava calibre on paediatric trauma CT may be a useful predictor for the development of shock.

AIM: To investigate whether inferior vena cava (IVC) calibre on paediatric trauma computed tomography (CT) can help anticipate outcomes in children. MATERIALS AND METHODS: The imaging and clinical records of 52 paediatric trauma admissions to the level 1 major trauma centre at St George's Hospital, London, UK, were retrospectively reviewed. The IVC dimensions, evidence of significant haemorrhage on CT, and the presence of components of the classical hypoperfusion complex, such as bowel and adrenal hyperenhancement, were recorded. Clinical data included observations at the time of admission and for the subsequent 48-hour period where available, blood gas results, length of stay, and mortality. RESULTS: There was a significant relationship between IVC dimensions in this cohort and the development of shock during the 24-hour admission period. IVC dimensions did not, however, reflect the haemodynamic status at the time of admission, and were not predictive of a longer hospital stay. There were no mortalities among the cases. A weak correlation was also seen with serum lactate, a finding that has also been seen in adults, but is of uncertain clinical significance. CONCLUSIONS: IVC calibre was found to be a more useful predictor of shock than heart rate or blood pressure, and may, therefore, prove to be a useful predictor of impending haemodynamic instability in children as it is in adults. Although the study was carried out at a busy unit, the numbers are acknowledged to be small and a larger study would be needed to validate these findings and identify whether there is any variation in the CT appearances between different age groups.

Left ventricular aneurysm in a four-year-old child: a diagnostic challenge.

We describe spontaneous rupture of a congenital left ventricular (LV) aneurysm with subsequent tamponade and cardiac arrest in a 4-year-old male with staphylococcal septicemia. Emergency resuscitation, thoracotomy, and oversewing were successfully undertaken in the pediatric intensive care unit. There was complete cardiovascular recovery without adverse neurodevelopmental sequelae.  This article details the difficulties in determining the etiology of ventricular aneurysms but highlights the importance of attempting to do so, particularly in distinguishing between congenital and acquired forms. Congenital aneurysms are usually a stable pathology; mycotic aneurysms are not and should be managed emergently, as survival after rupture is rare.

Is sonographically demonstrated mild distal ureteric dilatation predictive of vesicoureteric reflux as seen on micturating cystourethrography?

BACKGROUND: In most paediatric units, the micturating cystourethrogram (MCU) is the gold standard in the diagnosis of vesicoureteric reflux (VUR). Because of the well-known difficulties associated with MCUs, there is interest in any imaging finding which may be predictive of the absence of VUR with enough confidence to avoid the necessity for an MCU. OBJECTIVE: To evaluate whether incorporation of measurement of the internal diameter of the retrovesical ureter into a routine urinary tract US protocol can provide a useful predictor of VUR. MATERIALS AND METHODS: The radiology information system at the Royal Alexandra Children's Hospital in Brighton was searched to identify children who had urinary tract US and an MCU within 3 months of each other. This identified 285 renal units in 144 patients. The presence and grade of VUR on the MCU was then compared with the presence or absence of mild-to-moderate distal ureteric dilation, using 3.5 mm as the upppr limit of normal for the retrovesical ureter on US. RESULTS: A distal ureteric diameter of more than 3.5 mm on US is predictive of VUR with a sensitivity of 0.63 and specificity of 0.78. Figures for dilating VUR (grades 3-5) were 0.78 and 0.77, respectively. The negative predictive value of a ureteric calibre less than 3.5 mm in excluding dilating reflux was 0.96. Interestingly, all three solitary renal units had ureteric diameters of more than 3.5 mm but no VUR. CONCLUSIONS: Absence of distal ureteric dilation on US, on its own, cannot reliably exclude VUR. It does, however, make dilating reflux unlikely. We believe US measurement of the distal ureteric diameter is a useful additional tool in everyday assessment of children who might have reflux.

Antioxidants as therapy in the newborn: some words of caution.

Reactive oxygen and nitrogen species are considered to play a major role in the pathogenesis of a wide range of human disorders. This may be a particularly important pathogenetic mechanism in the newborn nursery. The phrase "oxygen radical disease of prematurity" has been coined to collectively describe a wide range of neonatal disorders based on the belief that premature newborns are deficient in antioxidant defenses at a time when they are subjected to acute and chronic oxidant stresses. This belief has led to a number of clinical trials of antioxidant therapies being undertaken in neonatal patients. The realization that reactive oxygen species play a critical role in neonatal illnesses has only recently been paralleled by an increased understanding of their physiologic roles. A major concern is that effective scavenging of reactive oxygen species, to attenuate their toxic effects, will also inhibit essential cellular functions such as growth in potential target organs such as lung, brain, intestine, and retina.