Eduardo Just da Costa e Silva

Eliminating Unenhanced CT When Evaluating Abdominal Neoplasms in Children

OBJECTIVE. The purpose of our study was to evaluate a CT protocol that eliminates the unenhanced phase for imaging pediatric abdominal neoplasms.MATERIALS AND METHODS. We retrospectively performed a case series study of all the abdominal CT scans on children and adolescents found in our archives. Two radiologists separately evaluated each CT scan twice. The radiologists were separately asked to formulate the most probable diagnosis and to decide whether tumor calcification was present. The first evaluation was performed without the unenhanced phase and the second was done with both the unenhanced and the contrast-enhanced scans. The agreement between the two methods, and that between each method and the histopathologic results, were measured using kappa statistics. The sensitivity and specificity of each method for diagnosing the more frequent neoplasms were also measured. The sensitivity and specificity of the contrast-enhanced CT scans were assessed for detecting calcification without reference to the u...

Quality of life, cognitive level and school performance in children with functional lower urinary tract dysfunction.

INTRODUCTION Lower urinary tract dysfunction (LUTD) are voiding dysfunctions without anatomical or neurological defects. The diagnosis is primarily clinical, with symptoms standardized by the International Childrens Continence Society. Few studies relate quality of life of patients with cognitive and school performance. OBJECTIVE To evaluate milestones of bladder control, daily problems, quality of life (QoL), cognitive function and school performance of children with LUTD. METHODS Case series of patients followed in the Pediatric Nephrology tertiary hospital with assessment of QoL (Pediatric Quality of Life Inventory - PedsQoL version 4), School Performance Test (TDE) and Raven Progressive Matrices test. RESULTS Girls of lower social class were (90.9%) of eligible children. The mean age was 9.1 ± 4.8 years old. The most common symptoms were urge incontinence (81%), holding maneuvers (77.3%) and enuresis (59.1%) associated with the elimination disorder syndrome (63.6%). Caregivers considered volunteers urinary losses and/ or symptoms, and fought and/or beat the child. Children had been subjected to embarrassing situations such as warnings of teachers, they hid symptoms and/or the dirty clothes. Mean score of QoL was 71.0 ± 12.6 with the lowest mean score on the school dimension. In TDE 55% had lower performance and in Raven Matrices 60% were intellectually in the medium level. It was observed lower QoL scores in the medium and lower level of TDE and average intellectual capacity/below average in Raven matrices. CONCLUSION LUTD may negatively affect family and social relationships, school performance and QoL of children with the dysfunction.

Agreement on Radiological Diagnosis of Acute Lower Respiratory Tract Infection in Children

Chest radiographs are often used to support the decision to use antibiotics in children aged <5 years with moderate to severe lower acute respiratory infection (ARI). This study aimed to evaluate inter-observer agreement in the interpretation of chest radiographs of children with suspected lower ARI. Three experienced paediatric sub-specialists: a radiologist, an intensivist and a pulmonologist were provided with basic clinical information on each of 48 cases, but the individual standardized evaluations were blinded for clinical diagnoses and for the assessment by the other two specialists. While for specific radiographic findings Kappa agreement values revealed considerable variation, agreement was higher (fair to substantial) on overall diagnostic impression. These findings reiterate that radiographs of children with a clinical suspicion of lower ARI are a limited but potentially useful resource for case management.

Linfangiectasia renal: conhecer para diagnosticar

Radiol Bras. 2016 Nov/Dez;49(6):406–413 408 http://dx.doi.org/10.1590/0100-3984.2015.0190 There is a broad spectrum of diagnoses of bilateral lesions in the basal ganglia in the pediatric population. The main causes cited are hypoxic-ischemic encephalopathy; hypoglycemia; encephalitis; inborn errors of metabolism; water and electrolyte disturbances; carbon monoxide poisoning; and demyelinating disorders. The correlation with clinical and laboratory data is fundamental for making the definitive diagnosis. In conclusion, the possibility of acute or chronic kernicterus should be considered when clinical symptoms, biochemical data, and MRI findings are suggestive of the disease, the chronic presentation and permanent, irreversible profile being promoted by bilirubin neurotoxicity.

Left pulmonary artery ligation

A 10-month-old boy presented with recurrent respiratory infections since he was 2 months old. He was born prematurely, and an open thoracotomy closure of patent ductus arteriosus was performed in the first month of life. Bronchiolitis obliterans and bronchopulmonary dysplasia were suspected at that time. Since he came from another hospital, no imaging studies were available. Chest radiograph at 10 months old shows a hyperlucent left hemithorax and signs of previous thoracotomy (Fig. 1). CT shows a poorly vascularized left lung, a patent ductus arteriosus and ligation of the left pulmonary artery (Fig. 2). Surgical correction was ineffective because the left pulmonary artery was no longer viable. Inadvertent ligation of the pulmonary artery is a rare complication of surgical closure of patent ductus arteriosus [1]. Jaffe et al. [2] reported five patients, diagnosed 1 day to 5 years after surgical procedure. Asymmetrical pulmonary blood flow should raise suspicion of this rare complication in the proper clinical setting. Prompt recognition is important for surgical repair to be feasible.

The aurora sign in a patient with type B Niemann-Pick disease

The aurora sign, a sonographic sign found on the sagittal and transverse view, refers to multiple bands of ring-down artifacts posterior to the right hemidiaphragm. Parenchymal lung disease should be suspected when this is present. We report a case of type B Niemann-Pick disease with pulmonary involvement and the aurora sign on abdominal sonography. High-resolution CT of the chest showed corresponding thickened interlobular septa.The aurora sign, a sonographic sign found on the sagittal and transverse view, refers to multiple bands of ring-down artifacts posterior to the right hemidiaphragm. Parenchymal lung disease should be suspected when this is present. We report a case of type B Niemann-Pick disease with pulmonary involvement and the aurora sign on abdominal sonography. High-resolution CT of the chest showed corresponding thickened interlobular septa.

Estimulação elétrica nervosa transcutânea para tratamento de urgência ou urge-incontinência urinária em crianças e adolescentes: ensaio clínico fase II

OBJECTIVE To determine the effectiveness of 20 twice-weekly sessions of parasacral transcutaneous electrical neural stimulation (TENS) for treatment of urinary urgency and urge-incontinence in children and adolescents. METHODS A Phase II clinical trial was carried out with patients with urinary urgency or urge-incontinence aged between 5 and 14 years. Twenty TENS sessions were conducted, twice weekly, using a Quark® Dualpex 961 apparatus. The variables analyzed were daily micturition, dynamics ultrasonography of the lower urinary tract pre-and post-treatment and responses to a questionnaire on urinary leakage applied during each session. RESULTS The mean age of the 25 children participating in the study was 7.80 ± 2.22 years, most were female (92%) and had urge-incontinence (92%). The difference in urinary leakage pre- and post-treatment was statistically significant ( p = 0.04); a decline in the symptom of urinary leakage was reported by all caregivers in children who completed the 20th session; the ultrasound parameters, although not statistically significant, showed a reduction in the percentage of children with detrusor contractions (from 62.5% to 43.5%); and a more adequate pre-micturition bladder volume of 4.2% post-treatment compared with 19.0% prior to treatment. DISCUSSION The electro-stimulation carried out during the twice weekly sessions appeared to be effective and urinary incontinence declined in half of the patients from the 12th session onwards. However, there is a need for a study involving a larger number of patients to confirm the results obtained.

Contribuição da ultrassonografia abdominal para o diagnóstico da doença celíaca em crianças e adolescentes

Objectives: to compared clinical characteristics and ultrasound parameters in a group of children and adolescents recently diagnosed with celiac disease with a control group. Methods: a clinical study was carried out with a sample of 20 patients recently diagnosed with celiac disease and 35 patients without the disease and with no symptoms of it. Abdominal ultrasound examinations were carried out with all patients. The cases underwent ultrasound examination during the diagnostic investigation phase, when they were still consuming gluten. Ultrasound and Doppler parameters related to the characteristics of intestinal folds, lymphonodular megaly and alterations in splanchnic blood flow were measured. The differences in proportions between the two groups were evaluated using the chi-squared and Fishers exact test and the difference between means using Students t test. Results: the principal clinical manifestations related to celiac disease were digestive ones, such as diarrhea (12/20), abdominal pain (14/20) and swelling of the abdomen (15/20). Patients with celiac disease presented with a larger transverse diameter of the folds of the small intestine (p=0.001), greater intestinal peristalsis (p=0.002), increased liquid content in the intestines (p=0.02), and thickening of the intestine wall (p<0.001). Conclusions: alterations suggestive of poor digestion/absorption (increased diameter of the transverse folds of the small intestine, greater intestinal peristalsis, increased liquid content) and thickening of the intestine wall in patients complaining of digestive problems should alert clinicians to investigate the possibility of celiac disease.

Formato da onda do jato ureteral ao estudo Doppler espectral: comparação interobservadores. Estudo prospectivo em crianças assintomáticas

OBJETIVO: Diagnostico precoce de disturbios miccionais pode diminuir as repercussoes sociais e psicologicas e evitar lesoes renais. O jato ureteral pode ser avaliado por estudo Doppler, metodo que apresenta boa associacao com dados clinicos dos pacientes no que diz respeito ao diagnostico de disfuncao miccional. O objetivo deste estudo e avaliar a concordância interobservadores entre os tipos de jato ureteral. MATERIAIS E METODOS: Estudo prospectivo de concordância interobservadores. Um total de 41 pacientes foi examinado sequencialmente por dois medicos ultrassonografistas. Para cada paciente, tres curvas dopplerfluxometricas foram obtidas de jatos consecutivos de cada ureter. O numero de picos em cada curva foi observado e classificado. A velocidade maxima do maior pico de cada onda foi observada. Coeficientes kappa (κ) foram calculados. RESULTADOS: A concordância interobservadores foi moderada (κ = 0,48; intervalo de confianca 95%: 0,36-0,60). O padrao plato foi o mais frequente. As velocidades maximas dos ureteres, medidas pelos dois observadores, foram de 32,37 cm/s e 35,63 cm/s, respectivamente. CONCLUSAO: O exame das curvas dopplerfluxometricas do jato ureteral e metodo que demonstrou moderada concordância interobservadores.

Congenital hepatic shunt

A 9-day-old boy presented to our emergency department with jaundice since birth. Laboratory tests showed marked unconjugated hyperbilirubinemia. Liver US showed an abnormal intrahepatic connection (curved arrows) between the right portal vein (red arrows) and right hepatic vein (white arrows). A turbulent Doppler pattern was noted in the portal vein (Fig 1). No other imaging was performed. At 8 weeks of age, unconjugated bilirubin levels were lower but still abnormal. At the time of this report, the patient was being monitored and had no clinical manifestations of the shunt. Congenital intrahepatic portosystemic shunts are rare and can be found incidentally in asymptomatic patients [1, 2]. When present, symptoms can include hepatomegaly, metabolic disorders, encephalopathy, and jaundice [2]. CT and MRI can provide additional information, but color Doppler US is often the first diagnostic imaging test and may be