Catherine Christophe

Characteristics of first urinary tract infection with fever in children: A prospective clinical and imaging study

Background: Our objective is to provide the clinical characteristics, uropathogen frequencies, and antimicrobial resistance rates of first urinary tract infection (UTI) diagnosed in febrile Belgian children. The ability of noninvasive ultrasound to detect renal abnormalities and vesicoureteral reflux (VUR) in these patients was also assessed. Methods: We prospectively followed (median, 20 months) 209 children treated for first febrile UTI. Renal ultrasound (US) and voiding cystourethrography examinations were performed in all patients. Results: Among these children, 63% were females and 37% were males, and 75% of them had their first UTI before the age of 2 years. The most common causative agent was Escherichia coli (91% of cases) with high rate resistance to ampicillin (58%) and trimethoprim/sulfamethoxazole (38%). Of these children, 25% had evidence of VUR (15 boys and 38 girls). VUR was of low grade in 85% of cases. The overall performance of renal US as a diagnostic test to detect significant uropathies excluding low-grade VUR was excellent; the sensitivity attained 97% and the specificity 94%. Conclusion: Girls represent 63% of cases with first UTI. For 91% of UTIs, Escherichia coli is held responsible with a high rate of resistance to ampicillin and trimethoprim/sulfamethoxazole. US is an excellent screening tool that allows avoidance of unjustified voiding cystourethrography studies.

A public hearing "Shaken baby syndrome: guidelines on establishing a robust diagnosis and the procedures to be adopted by healthcare and social services staff". Guidelines issued by the Hearing Commission.

A. Laurent-Vannier *, M. Nathanson , F. Quiriau , E. Briand-Huchet , J. Cook , T. Billette de Villemeur , J. Chazal , C. Christophe , S. Defoort-Dhellemmes , G. Fortin , C. Rambaud , J.S. Raul , C. Rey-Salmon , F. Sottet , E. Vieux , M. Vinchon , R. Willinger q,4 a Service de rééducation des pathologies neurologiques acquises de l’enfant, hôpitaux de Saint-Maurice, 14, rue du val d’Osne, 94415 Saint-Maurice cedex, France b Hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France c CNAPE (convention nationale des associations de protection de l’enfant), 118, rue du Château-des-Rentiers, 75013 Paris, France d Hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 32141 Clamart cedex, France e CERMES, site CNRS, 7, rue Guy-Moquet, 94801 Villejuif cedex, France f Service de neuropédiatrie, hôpital Trousseau, 26, rue Arnold-Netter, 75571 Paris cedex 12, France g Service de neurochirurgie, CHRU Clermont-Ferrand – Gabriel-Montpied, 58, boulevard Montalembert, 63003 Clermont-Ferrand, France h Hôpital universitaire des enfants Reine-Fabiola, avenue J.J.-Crocq 15, 1020 Bruxelles, Belgium i Service d’exploration de la vision et neuro-ophtalmologie, hôpital R.-Salengro, rue du Pr Émile-Laine, 59037 Lille cedex, France j CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, Montréal H3T 1C5, Québec, Canada k Service d’anatomie pathologique et médecine légale, hôpital Raymond-Poincaré, 92380 Garches, France l Institut de médecine légale, 11, rue Humann, 67085 Strasbourg cedex, France m Unité médico-judicaire, Hôtel Dieu, 1, place du Parvis-Notre-Dame, 75181 Paris, France n TGI, section du parquet des mineurs, 4, boulevard du Palais, 75055 Paris, France o Présidente de chambre à la Cour d’appel, 75055 Paris, France p Service de neurochirurgie pédiatrique, hôpital Roger-Salengro, CHU de Lille, 59037 Lille cedex, France q Institut de mécanique des fluides et des solides, département systèmes biomécaniques, transports et sécurité, 2, rue Boussingault, 67000 Strasbourg, France

Ultrasound: A method for kidney size monitoring in children

Normal kidneys were studied echographically in 170 children from 0–15 years of age. The length, thickness, width, volume and largest sagittal and transverse areas were measured and plotted against the childrens height and body surface to establish standard growth curves.The usefulness of this non-invasive inter-and intra-individual estimation of renal size in following the progress of kidney alteration in children was illustrated in one case of malakoplakia and one case of parenchymal scars.

Bilateral congenital absence of the internal carotid artery with a primitive transmaxillary arterial anastomosis

We report a case of congenital, bilateral absence of the internal carotid artery accompanied by a complex anastomotic plexus arising from the right maxillary artery, a terminal branch of the external carotid artery. We present the clinical features and the radiological diagnostic evidence which consisted of ultrasonography, brain CT and MRI, conventional angiography and skull base CT scan. We review the literature pertaining to this congenital anomaly and correlate embryology of the carotid arteries to this unusual type of collateral circulation.

Gaucher's disease : plain radiography, US, CT and MR diagnosis of lungs, bone and liver lesions

We report our observations made by conventional radiography, ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI) on a 31/2-year-old girl with Gauchers disease. The interest of the case consists in the exceptional lungs involvement, the demonstration by MRI of the bone marrow involvement and the necrosis and fibrosis of the liver, as shown by CT. This liver complication has been previously reported only once.

Predicting the clinical outcome of antenatally detected unilateral pelviureteric junction stenosis.

OBJECTIVE To determine, in children with antenatally detected pelviureteric junction (PUJ) stenosis, what factors may be predictive for deterioration of differential renal function (DRF) in case of conservative treatment or improvement of DRF in case of pyeloplasty. METHODS This study analyzed and compared the initial level of hydronephrosis, DRF, quality of renal drainage, and cortical transit with the late DRF outcome. We reviewed the medical charts of 161 consecutive children with antenatally diagnosed PUJ stenosis during a 10-year period (between 1997 and 2007). From this cohort, we retained 81 children with unilateral PUJ and strictly normal contralateral kidney, with a median follow-up of 67 months. Repeated ultrasounds, voiding cystourethrography, and radionuclide renograms were performed in all children. RESULTS Fifty patients never underwent a surgical intervention (62%), whereas surgical repair (Anderson-Hynes dismembered pyeloplasty) was performed in 31 (38%). During conservative follow-up, DRF deterioration was observed in 11% of patients. After pyeloplasty, DRF improvement was observed in 25% of patients. Abnormal cortical transit was the only predictive factor of DRF deterioration in case of conservative approach, whereas the initial degree of hydronephrosis, or renal drainage, and the initial DRF level were not predictive. In children who were operated on, only impaired cortical transit was predictive of DRF improvement postoperatively. CONCLUSION Conservative management of children with unilateral PUJ stenosis is a safe procedure. Impaired cortical transit although imperfect, seems the best criterion for identifying children for whom pyeloplasty is warranted.

Early MR detection of cortical and subcortical hypoxic-ischemic encephalopathy in full-term-infants

Four observations illustrate the potential of MR imaging in the early depiction of multiple types of neuropathologic lesions which may coexist in the fullterm newborn, upon severe hypoxic-ischemic encephalopathy (HIE). In particular, diffuse, postnatal involvement of cerebral cortex and subcortical white matter (WM) is demonstrated. Cortical hyperintensity on both proton-density- and T1-weighted images is probably related to cellular necrosis which is distributed diffusely or parasagittally. Hyperintense, frontal, subcortical WM edging on proton-density-weighted images results from the increase of water concentration, induced either by infarct or by edema. Diffuse WM areas of low intensity on T1-weighted images and of high intensity on T2-weighted images are presumably related to cytotoxic and/or vasogenic edema, proportional to the underlying damaged tissues. On follow-up MR examinations, several months later, the importance of cortical atrophy and of the myelination delay appeared related to the importance of the lesions detected during the postnatal period.

Clinical evaluation of gadodiamide injection in paediatric MR imaging

The safety and efficacy of intravenous gadodiamide injection, 0.1 mmol/kg body weight, have been evaluated in an open label, noncomparative as to drug, phase III clinical trial in 50 children from 6 months to 13 years of age, referred for MRI requiring the injection of a contrast medium. The central nervous system and other body areas were examined with T1 sequences before and after intravenous injection of the contrast medium. Overall safety was very good and no clinically relevant changes were evident as regards heart rate and venous blood oxygen saturation after injection. No adverse event or discomfort was experienced by conscious patients that could with certainty be related to the contrast medium, but slight movements were observed in two sedated patients that could be related to the injection. Comparing pre- and post-injection images, additional diagnostic information could be obtained from the latter in 41 patients (82 %). In these images, the number of lesions detected increased and they were generally better delineated and their size more easily estimated. The results of this trial indicate that gadodiamide injection is safe and effective for MRI examinations in children.

A public hearing. "Shaken baby syndrome: guidelines on establishing a robust diagnosis and the procedures to be adopted by healthcare and social services staff". Scoping report.

94415 Saint-Maurice cedex, France b Hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France c Convention nationale des associations de protection de l’enfant (CNAPE), 118, rue du Château-des-Rentiers, 75013 Paris, France d Hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 32141 Clamart cedex, France e CERMES, site CNRS, 7, rue Guy-Moquet, 94801 Villejuif cedex, France f Service de neuropédiatrie, hôpital Trousseau, 26, rue Arnold-Netter, 75571 Paris cedex 12, France g Service de neurochirurgie, CHRU Clermont-Ferrand–Gabriel-Montpied, 58, boulevard Montalembert, 63003 Clermont-Ferrand, France h Hôpital universitaire des enfants Reine-Fabiola, avenue J.J.-Crocq, 15, 1020 Bruxelles, Belgium i Service d’exploration de la vision et neuro-ophtalmologie, hôpital R.-Salengro, rue du Pr-Émile-Laine, 59037 Lille cedex, France j CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, Montréal, H3T 1C5, Québec, Canada k Service d’anatomie pathologique et médecine légale, hôpital Raymond-Poincaré, 92380 Garches, France l Institut de médecine légale, 11, rue Humann, 67085 Strasbourg cedex, France m Unité médicojudicaire, Hôtel-Dieu, 1, place du Parvis-Notre-Dame, 75181 Paris, France n TGI, section du parquet des mineurs, 4, boulevard du Palais, 75055 Paris, France o Cour d’appel de Paris, 75055 Paris, France p Service de neurochirurgie pédiatrique, hôpital Roger-Salengro, CHU, 59037 Lille cedex, France q Département systèmes biomécaniques, transports et sécurité, institut de mécanique des fluides et des solides, 2, rue Boussingault,

Ultrasound computed tomography and magnetic resonance of a neonatal ganglioglioma of the brain

Ganglioglioma is an uncommon nervescell tumour (0,4% of all brain tumours). In 800 brain tumours in children, Garrido et al. (Toronto) found I4 gangliogliomas (1.7%) [1]. To our knowledge, ganglioglioma has not been reported in children under 2½ years of age. We haveincidentally discovered a ganglioglioma in a 3-day-old girl. Appearance on US, CT and MR are described and discussed.