[A mistaken diagnosis of urinary tract infection in a 6-year-old girl].
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Biomedical subjects
Publications and source records attributed to H Ducou Le Pointe.
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We report a case of chondroblastoma involving the upper tibial epiphysis, which had an unusually aggressive course, with articular involvement at initial presentation. Intra-articular and soft tissue recurrence occurred after treatment consisting of curettage and bone grafting. Although the incidence of local intraosseous recurrence of chondroblastoma is relatively high, intra-articular and soft tissue implantation is rare and is usually due to intra-articular spillage during surgery. Spontaneous articular involvement is rarely seen.
With the progress of foetal ultrasonography, diagnosis of foetal tumors can be made before birth. We report five cases of prenatally detected neuroblastoma of the adrenal glands. Diagnosis was made during the third trimester in all cases. At birth no clinical sign related to the tumor was present, and urinary catecholamines were within normal ranges. On ultrasound scans the tumor was cystic in 1 case, solid in 2 cases and of mixed echogenicity in 2 cases. All children were operated on without pre or postoperative chemotherapy. In each setting the tumor was a stage I neuroblastoma according to the Evans classification. All children are alive and disease-free with a follow-up of 32 months at 14 years.
The three main categories of limb emergencies are trauma, infection and the painful hip. Conventional radiography is used as the initial screening imaging modality that can sometimes be complemented with sonography. Computed tomography and MRI are rarely needed. Familiarity with conditions specific to the pediatric population is essential to the diagnosis and management of these patients. Traumatic injuries in children involve growing bones with large cartilaginous component and biomechanical resistance different from that in adults. Lim infections in children are affected by the characteristic vascular supply to the metaphyseal-epiphyseal region, the intra-articular location of the metaphysis, and loose periosteal attachment. Limping (transient synovitis, Legg-Calvé-Perthes disease and slipped capital femoral epiphysis) is frequent cause of consultation and diagnosis relies on the patient's age and plain film findings.
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Acute or rapidly progressive visual loss in children needs urgent attention and treatment. It may be unilateral orbilateral. Etiology depends upon the involved areas: eye ball, optic nerve, retro-chiasmatic pathways. Psychogenic origin is quite common in school-age children, however, it has to be considered last. Unilateral visual loss may be overlooked. Acute total transitory visual loss may be due to epilepsy or to migraine. Rapidly progressive visual loss may be due to retinal disease, optic neuritis or cortical blindness. Management of visual loss depends on clinical features, associated symptoms, and aspect of the optic disc. It needs collaboration between ophthalmologist,pediatrician and neuropediatrician. Retinal hemorrhages first call to mind a traumatic origin. Swelling of the optic disc may be due to increased intracranial pressure or due to optic neuritis. When the optic disc is normal it is necessary to rule out organic diseases before establishing the diagnosis of a psychogenic vision disturbance. In emergency, brain neuroimaging is the best way to diagnose intracranial mass and visualize optic pathways.
Conventional imaging will be totally replaced by digital imaging because of the lower exposure dosage and the clear advantages in terms of image processing, transfer and storage. Reports in the literature have demonstrated that a 2.5 pl/mm spatial resolution is satisfactory to detect a pneumothorax, a parenchymal nodule or a mediastinal mass. For most authors, this resolution is also sufficient to detect an interstitial syndrome. Digitalization by amplification or by particle detectors using wire chambers are not, for the time being, acceptable for interpretation of a simple chest image because of the low spatial resolution. The selenium cylinder is an adapted technology dedicated to chest imaging. Memory display screens can be used to digitalize the entire radiology unit. They are perfectly adapted for bedside imaging. Flat detectors are based on direct or indirect conversion of the X photons into an electrical signal during the clinical evaluation. The early results appear most promising.
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A 7-year-old girl presented with an abdominal cystic mass close to the pancreas. US and CT could not identify its origin. The diagnosis of duplication of the transverse colon was made at surgery. This location is rare. The differential diagnosis in this case included a pancreatic cystadenoma, a pseudocyst or a mesenteric cyst.
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PURPOSE: To determine whether the simple technique of dynamic gadolinium-enhanced subtraction MR imaging, which is available on standard MR units, can detect ischemia of the femoral head in children with early Legg-Calvé-Perthes disease (LCP). MATERIALS AND METHODS: Bone perfusion of eight hips in four patients (mean age 7.5 years) was studied using dynamic gadolinium-enhanced subtraction MR imaging at the onset of proven LCP (with initial negative plain films). Enhancement of subtracted images was compared with that on standard MR images and with bone scintigraphy findings. RESULTS: Subtraction MR imaging depicted ischemia as a widespread absence of enhancement and was in good agreement with bone scintigraphy. The subtraction technique improved the sensitivity and the specificity of MR imaging in two children. Furthermore, subtraction MR imaging allowed recognition of the pattern of early reperfusion. CONCLUSION: Our preliminary results indicate that dynamic gadolinium-enhanced subtraction MRI is a simple and promising means of early recognition of ischemia in LCP.
We report a case of traumatic duodenal hematoma. The patient's age (2.5 y.) and the absence of evidence of trauma when the symptoms began led to perform plain films of the abdomen, upper GI series, US, CT, and MR. This excess of imaging modalities emphasize the diagnostic value of plain X Rays of the abdomen and opacification of the duodenum.
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Teleradiology consists of the transmission of radiological images from one point to another. The use of a commercial telephone network allows easy and inexpensive transmission. Numerous applications are possible: management of patient transfers (for example the neurosurgery emergency service), distant interpretation of radiological images (telediagnosis), faster return of urgent examinations (direct transmission to examination monitors in medical or surgical emergency departments). Teleradiology raises technical problems: data entry (as not all radiological images are digitalised), quality and duration of transfer time, quality of display monitors; medicolegal problems: medical responsibility as well as storage (magnetic, magneto-optical or optical supports are not legally recognised at the present time). Although only in the early stages in France, teleradiology is being developed with relatively inexpensive equipment which can be described as an "image telephone".