J. F. De Campo

Differentiating bacterial from viral pneumonias in children

Abstract58 paediatric patients with pneumonia, in whom an etiological agent had been isolated, were reviewed. The patients were designated to have either viral or bacterial pneumonia on the basis of proposed clinical and radiological criteria. These presumed diagnoses were then compared to the microbiologically proven diagnosis. When clinical features suggested a bacterial infection the chance of isolating a bacteria as opposed to a virus was 18%. When radiological features suggested a bacterial infection the chance of isolating a bacteria as opposed to a virus was 30%. Thus the commonest cause of “bacterial” clinical and radiological features is a viral infection and the proposed criteria do not allow differentiation of bacterial from viral pneumonia.

Radiological findings in total aganglionosis coli.

The radiological findings in 13 patients with total aganglionosis coli were reviewed. There was a male to female ratio of 7:6. Fifty-four percent of patients presented in the first week of life, but a significant number (31%) did not present until after 1 month of age. All patients had plain film evidence of bowel obstruction when referred for a barium enema. There were no pathognomonic barium enema findings, and barium enema results covered the entire spectrum of findings which can be encountered in the neonate and young infant with bowel obstruction. Seventy-seven percent had normal calibre colon, 23% had micro colon, 23% had a shortened colon, 46% had colonic wall irregularity, 33% had significant ileal reflux. Delayed evacuation of barium from colon occurred in the two patients who had delayed films. Total colonic aganglionosis should be considered in any infant or young child with plain film evidence of bowel obstruction, whatever the barium enema findings. Hirschsprungs disease and the level of transition can only be definitively diagnosed by biopsy.

Paediatric pulmonary nodules: a comparison of computed tomography, thoracotomy findings and histology

Eighteen computed tomography (CT) studies of the lungs prior to thoracotomy in 15 children with presumed pulmonary metastases were compared retrospectively with surgical and pathological findings. Computed tomography detected 86% of the malignant lesions and technical factors were thought to be important where larger nodules were missed. Although CT does not differentiate benign and malignant lesions, 90% of lesions detected at CT in this study contained tumour. In four patients it was found that nodules that increased in size on serial CT contained viable tumour, whereas nodules that decreased in size while a patient was on chemotherapy might or might not contain viable tumour.

Ultrasound of primary hepatic tumours in childhood

Ultrasound scans of 18 children with primary hepatic tumours were reviewed to assess the accuracy of ultrasound in determining hepatic origin, extent, resectability, and histology. Using basic landmarks, ultrasound correctly predicted extent and resectability in 72% of patients. Accuracy would be increased by more detailed scanning to determine segmental and lobar landmarks. Hepatoblastoma demonstrated a characteristic appearance of a well-defined hyperechoic mass. Other tumour types showed some overlap in ultrasound appearances. Ultrasound examination overestimated the incidence of obliteration of the IVC lumen, and such patients require inferior venacavography to assess the true status of the cava preoperatively.

Measurement of leg length by computerised tomographic scanography: brief report

We describe a technique for the accurate measurement of total leg length, including heel height. Computerised tomography (CT) can be used to measure the length of each tibia and femur (Helms and McCarthy 1984) but this technique cannot measure discrepancy of leg length distal to the ankle. The heel height may be a significant component of total discrepancy. Our technique allows this to be measured accurately with the foot in the same relationship to the tibia as in the standing position. It is a quick method with 50 to 100 times less radiation than orthoroentgenography (Green, Wyatt and Anderson 1946).

Gas reduction of intussusception.

Efforts to improve the non-surgical management of childhood intussusception centre around (a) reassessment of selection criteria used to ensure as many children as possible have the advantage of hydrostatic reduction, and (b) improvements and modifications of enema technique to ensure successful and safe reductions without increased morbidity. Reports that pneumatic reduction was highly successful in treating childhood intussusception prompted the authors to evaluate this technique over an 18 month period using our previously reported technique of oxygen at 2 litres/minute and a pressure of 80 mm Hg. Pneumatic reduction was attempted in 114 of 129 consecutive cases of intussusception, and was successful in 85 (75%). Fifteen patients (8.6%) were considered unacceptable risks for gas reduction using our current selection criteria and had primary surgery. The overall success rate considering all cases of intussusception managed at our institution over this period was 66% (85/129). As with any form of hydrostatic reduction, pneumatic reduction of intussusception requires careful selection of patients, meticulous technique, and awareness of complications and their appropriate management. Because of its simplicity and improved success rate, pneumatic reduction has replaced traditional barium reduction at our institution. It may be that with further evaluation of selection criteria, higher pressures, and prolonged attempts that results will improve further.

Computed tomography of partial growth plate arrest: initial experience

Twelve growth plates in 11 patients with clinical evidence of partial growth plate tethering underwent thin slice (1.5 mm) axial high resolution computed tomography (CT), or direct coronal CT. The normal epiphyseal plate was readily visualised as a low density layer of soft tissue density between adjacent sclerotic margins of epiphysis and metaphysis. Two growth plates had greater than 50% obliteration and ten had partial obliteration. Our preliminary results show excellent correlation between the CT findings and surgical pathology. We expect that CT will replace polytomography in the operative evaluation of partial growth plate arrest, as it has in our institution.Twelve growth plates in 11 patients with clinical evidence of partial growth plate tethering underwent thin slice (1.5 mm) axial high resolution computed tomography (CT), or direct coronal CT. The normal epiphyseal plate was readily visualised as a low density layer of soft tissue density between adjacent sclerotic margins of epiphysis and metaphysis. Two growth plates had greater than 50% obliteration and ten had partial obliteration. Our preliminary results show excellent correlation between the CT findings and surgical pathology. We expect that CT will replace polytomography in the operative evaluation of partial growth plate arrest, as it has in our institution.

Is the preliminary film necessary prior to the micturating cystourethrogram in children

The aim of the study was to determine the value of the preliminary film in children undergoing a micturating cystourethrogram (MCU). The coded computer reports of 806 children undergoing MCUs in a 12-month period were retrospectively reviewed for abnormalities of the lumbar spine, hips, or for calcifications. Vesicoureteric reflux was present in 185 patients (23%). Four patients had renal calculi (0.5%), and in all cases the abnormality was evident on preceding imaging of the upper urinary tract. Spinal anomalies (other than known meningomyelocele) were present in four patients. The clinically obvious abnormalities present in these were a sacral teratoma, a sacral lipoma, scoliosis with tracheo-oesophageal fistula, and a cutaneous angioma with a sacral pit. No patients (other than those with known meningomyelocele) had dislocated hips diagnosed. If the preliminary film had not been performed in 806 patients, neither spinal anomaly, renal calculus, nor congenital dislocated hip would have been missed. The low incidence of plain film anomalies indicates that in our population a plain film is not justified routinely.