Survey of the current practices for neonatal gastrointestinal contrast studies in Australia.

A wide range of contrast agents with varying osmolality (290-849 mmol/kg) and iodine content (150-370 mg/mL) are currently available for neonatal gastrointestinal contrast studies. A nationwide survey was hence conducted to identify current practices. A questionnaire was mailed to the 22 Australian neonatal units registered with the Australian and New Zealand Neonatal Network. Seventeen (72%) of the 22 units responded to the questionnaire and 54% had some guidelines for term neonates. No unit had a specific policy for preterm neonates. Seventy-seven per cent of the respondents used a contrast agent with a high osmolality. There was a wide variation in the volume and dilution of contrast used. Guidelines for gastrointestinal contrast studies in high-risk neonates are suggested.

Relationship between renal volume and increased albumin excretion rates in children and adolescents with type 1 diabetes mellitus.

OBJECTIVE: To compare renal volume in a group of prepubertal and pubertal children with type 1 diabetes mellitus (DM) and either borderline microalbuminuria (BM) or intermittent microalbuminuria (IM) with a matched group of normoalbuminuric (NA) controls with DM. RESEARCH DESIGN AND METHODS: Twenty-one patients with BM or IM were matched for age, gender and duration of DM with an NA control group. Total renal volume (RV), measured by ultrasound, was corrected for body surface area. Long-term diabetes control was assessed by glycosylated haemoglobin levels. RESULTS: There were no significant differences in age, duration of DM or glycosylated haemoglobin levels between the groups. Those with BM or IM had significantly increased total renal volume (303 +/- 8.4 ml/1.73 m2) compared to those with NA (276.3 +/- 10 ml/1.73 m2) (T40=2.04, P=0.05). Multivariate modelling suggested that this association was independent of potential confounding covariates. While not formally significant (chi2(1)=2.53, P=0.12), the frequency of nephromegaly (RV >300 ml/1.73 m2) was doubled in children with BM or IM (47.6%) compared to controls (23.8%). Nephromegaly was not found in prepubertal patients. CONCLUSIONS: This study suggests that nephromegaly is more common in patients with borderline increases in urinary albumin excretion rates (AER) than those with normoalbuminuria. Prospective follow-up of those with increased renal volume is needed to determine whether nephromegaly is an early marker of incipient nephropathy.

Bleomycin therapy for cystic hygroma.

Intralesional bleomycin injection was used as sclerosant therapy for sixteen patients with cystic hygroma. An excellent (complete clinical resolution) response was obtained in seven (44%) patients, a good (> 50% response) result in seven (44%), and a poor or no response in two (12%). Minor transient side effects (fever, vomiting, cellulitis, skin discoloration) were seen in six patients, and there were no serious side effects. The results suggest that bleomycin intralesional sclerosant is effective therapy for cystic hygroma, with response rates comparable to those of surgical removal, but with the advantage of avoiding inadvertent nerve damage and scarring.

Torsion of accessory fallopian tube: ultrasound findings in two premenarchal girls.

The ultrasound findings of two cases of fallopian tube duplication, both of which had undergone torsion, are described. Two premenarchal girls were examined with ultrasound because of clinical evidence of pelvic pathology. Both were found to have complex cystic structures that on surgery and subsequent pathological examination were shown to be twisted accessory fallopian tubes. Accessory fallopian tubes have been reported to occur in 6-13% of selected patient groups. To our knowledge, torsion of an accessory tube has not been reported in the literature.

Left-side dominance of upper extremity fracture in children.

In 148 children who had sustained trauma to the upper extremities from falls, fractures were twice as common on the left as on the right side. This seemed to be due to the childrens' preferential use of the left hand to parry the fall even when both hands were free and because the left arm seemed to be more easily broken than the right arm during trauma.

Prediction of the stability of minimally displaced fractures of the lateral humeral condyle.

Fractures of the lateral humeral condyle run a great risk of subsequent displacement. This is also true--although to a lesser extent--for primarily non-displaced or minimally displaced (less than or equal to 2 mm) fractures. The present retrospective investigation aimed at defining radiographic criteria in order to predict the stability of non-displaced or minimally displaced fractures in 159 children. The fractures were classified according to radiographic criteria into 3 groups considered to represent stable, ambiguous and unstable fractures. Additional displacement while immobilized in plaster occurred in 2.6 per cent of the fractures classified as stable and in 44.4 per cent of those classified as unstable (p less than 0.001); in the ambiguous group subsequent displacement occurred in 24.1 per cent. It is concluded that the radiographic criteria should be useful to predict the stability of non-displaced or minimally displaced fractures of the lateral humeral condyle in children.

Pseudotumour of the kidney secondary to posterior urethral valves: the role of renal backflow and perirenal extravasation.

In three male neonates, successfully treated for posterior urethral valves, unilateral "pseudotumour" deformity of the collecting system ensued. Two of them had, preoperatively, a marked ipsilateral perirenal urinary extravasation (urinoma), one in addition gross contralateral renal backflow with moderate leakage to the renal capsule. The other one had slight contralateral backflow to the kidney parenchyma but also urinary ascites. The third patient had considerable unilateral renal backflow on the side of developing deformity but no perirenal extravasation. Out of the three patients, two had bilateral Grade IV-V vesico-ureteral reflux, in the third patient reflux of the same degree was present and this only on the side opposite to the deformity. In all three patients the kidney with the "pseudotumour" became taller and more slender than the normally developing mate. There was either slight or no loss of renal parenchyma. At the last follow-up, 1-3 years after diagnosis of the valves, kidney function was normal.

Conventional abdominal radiography as a means to rule out ileo-caecal intussusception.

The experiences gained with conventional radiographic examinations as a means of excluding childhood ileo-caecal intussusception are presented. According to these, a supplementary barium enema is indicated a) in patients under 6 months of age, b) in patients presenting with scant intestinal gas, c) in patients where the caecum cannot be outlined, d) in patients with a possible mass lesion of the colon, e) in patients with obstruction presumably due to intussusception, and f) in patients with discrepancy between the clinical and radiologic findings (1, 4). In all other patients the barium examination is not used. The key to a successful application of this protocol is a thorough familiarity with the limitations and potentials of the conventional abdominal examination.

Spontaneous regression of stage IV neuroblastoma.

Neuroblastoma presenting with wide spread osseous metastases (stage IV) is generally considered incurable. However, rare cases of spontaneous regression and cure are on record. This report deals with such a case in which an infant received steroids as sole treatment for developing skeletal pain. Established metastases to the brain, scalp and skeleton disappeared. Today 4 1/2 years later the patient is free from symptoms and signs of tumour.