Valeria Rathaus

Internal jugular vein thrombosis in patients with ovarian hyperstimulation syndrome

OBJECTIVE To describe a case of bilateral internal jugular vein thrombosis complicating ovarian hyperstimulation syndrome (OHSS). DESIGN Case report. SETTING Internal medicine ward in a teaching hospital. PATIENT A 28-year-old nulliparous woman undergoing IVF. INTERVENTION(S) Ultrasonographic Doppler of the neck veins was performed because of pain and swelling in the neck, and bilateral jugular vein thromboses were detected. Laboratory evaluation revealed activated protein C resistance caused by factor V Leiden mutation. Low-molecular-weight heparin (enoxaparin) was administered for the remainder of the pregnancy and for 6 weeks after delivery. MAIN OUTCOME MEASURE Resolution of jugular venous thromboses documented by ultrasonographic Doppler and normal progression of pregnancy. RESULT(S) The patient delivered healthy twins at term. There were no complications arising from the jugular vein thromboses or the low-molecular-weight heparin treatment. CONCLUSION(S) Unusually located venous thrombosis should prompt an evaluation for a hypercoagulable state. The high prevalence (4%-7%) of factor V Leiden mutation in most Western populations and the mutations potential contribution to thrombotic complications in OHSS suggest that screening for this abnormality in women undergoing IVF may be indicated.

Volvulus of the stomach in childhood: The spectrum of the disease

Introduction During a 5-year time frame, five cases of symptomatic gastric volvulus were diagnosed and treated in our department. Four presented with the acute form of gastric volvulus and underwent emergency surgery. The fifth suffered the chronic variant of the syndrome and was benefited by nonoperative management. The cases serve to remind emergency physicians of the spectrum of gastric volvulus. The report supplements the sparse clinical description in the emergency literature. Results In the operated patients, there were no postoperative complications. The outcome, to the time of publication, has been good in every instance. The history, etiology, presentation, and treatment of the disease are discussed in detail. Conclusions Not infrequently, gastric volvulus in children fails to exhibit the full gamut of signs and symptoms such as abdominal distension, vomiting, pain, and retching. For this, as well as for other stated reasons, symptomatic gastric volvulus in infancy and childhood may not be as rare as is commonly assumed.

A urethral catheter knot: A rare complication of cystourethrography

Complications of voiding cystourethrography are infrequent. We report a rare complication of knotting of the catheter within the bladder, necessitating surgical removal of the catheter through the urethra.

The distance from the skin to the subarachnoid space can be predicted in premature and former-premature infants.

PurposeSpinal anesthesia can be technically challenging in young infants. We studied whether the distance between the skin and the lumbar subarachnoid space in premature and former-premature young infants could be predicted prior to lumbar puncture.MethodsThe distance from skin entry point to tip of the spinal needle was measured using a caliper after lumbar spinal anesthesia at the L4–5 interspace. This distance was correlated to the patient’s weight, postconceptual age and lumbar ultrasonographic measurement of the skin-to-subarachnoid space and predictive statistical models were sought.ResultsThirty-five premature or former-premature infants were studied. Three models were examined: all three independent variables, weight and postconceptual age only, and weight only. The model selected contained the weight and postconceptual age, because it had the highest value for adjusted R squared, as well as the lowest value for the mean squared error. Adding the ultrasonic measurement to the model worsened the results. The statistical model that described the depth of the subarachnoid space at the L4–5 level was Y = 13.19 + 0.0026 × W −0.12 × PCA, where Y is the distance (mm) from the skin to the subarachnoid space, W is the patient’s weight (g) and PCA is the postconceptual age (weeks). Adjusted R squared was 0.72, mean square error was 2.63 and P< 10−9.ConclusionThe distance between the skin and the subarachnoid space at the level of L4–5 interspace can be predicted using a statistical model based on the infant’s weight and postconceptual age. Spinal ultrasound has no value in L4–5 subarachnoid space depth prediction.RésuméObjectifLa rachianesthésie peut être une technique intéressante à utiliser chez de jeunes enfants. Nous avons vérifié si la distance entre la peau et l’espace sous-arachnoïdien lombaire pouvait être prédite avant la ponction lombaire chez les enfants prématurés et anciens prématurés.MéthodeLa distance entre le point d’entrée cutanée et le bout de l’aiguille rachidienne a été mesurée à l’aide d’un compas à calibrer après la rachianesthésie au niveau L4–5. Cette distance a été mise en corrélation avec le poids du patient, l’âge gestationnel et la mesure échographique lombaire de la distance entre la peau et l’espace sousarachnoïdien; des modèles statistiques de prédiction ont été recherchés.RésultatsL’étude a porté sur 35 bébés prématurés ou anciens prématurés. Trois modèles ont été examinés : les trois variables indépendantes, le poids et l’âge gestationnel seulement, le poids seulement. Nous avons choisi le modèle comportant le poids et l’âge gestationnel, car il présentait la valeur la plus élevée pour le R carré ajusté, et la plus basse valeur pour l’erreur moyenne au carré. Le fait d’ajouter la mesure échographique au modèle a détérioré les résultats. Le modèle statistique qui décrivait la profondeur de l’espace sous-arachnoïdien au niveau L4–5 a été Y= 13,19 + 0,0026 × W −0,12 × APC, où Yest la distance (mm) entre la peau et l’espace sous-arachnoïdien, West le poids du patient (g) et APC est l’âge postconception (semaines). Le R carré ajusté a été de 0,72, l’erreur moyenne au carré a été de 2,63 et P < 10−9.ConclusionLa distance entre la peau et l’espace sous-arachnoïdien au niveau de l’espace intervertébral L4–5 peut être prédite par un modèle statistique fondé sur le poids et l’âge postconception de l’enfant. L’échographie rachidienne n’a pas de valeur pour prédire la profondeur de l’espace sous-arachnoïdien à L4–5.

Progressive liver calcifications in neonatal coxsackievirus infection

Abstract Coxsackievirus group B can cause a severe systemic disease in the perinatal period. Severe manifestations like meningitis, encephalitis, hepatitis, and myocarditis have been previously reported. A case of a twin neonate infected by coxsackievirus group B is described, who developed progressive extensive hepatic calcifications demonstrated by ultrasound and computed tomography with follow-up. Hepatic calcifications in coxsackievirus infection have not been previously reported.

Minimal pelvic fluid in asymptomatic children: The value of the sonographic finding

Objective. To determine the presence of minimal pelvic fluid in asymptomatic children who underwent abdominal sonography. Methods. Between August 1999 and January 2001, we performed abdominal sonography in 396 asymptomatic children and 266 symptomatic children (acute and chronic abdominal pain). The 2 groups were evaluated for the presence of minimal fluid in the pelvis. All the children were divided into 4 subgroups according to age and sex. Results. Minimal pelvic fluid was noted in 28 (7%) of the asymptomatic children, and it was more common in girls (10.2%), especially in girls between the ages of 5 and 15 years. On the contrary, no difference between the age groups was seen in boys. Minimal pelvic fluid was found in 76 (28.6%) of the symptomatic children, with no difference seen between the sexes or age groups. The presence of pelvic fluid was significantly greater in the symptomatic group than in asymptomatic group (P < .001). Conclusions. Our data suggest that the presence of minimal pelvic fluid in children of all ages and both sexes is a physiologic finding and should be evaluated in the appropriate clinical context.

The bubble sign in the gasless abdomen of the newborn.

The bubble sign (BS) in the gasless abdomen of the newborn is a helpful clue in the diagnosis of an upper gastrointestinal obstruction. The already swallowed air serves as the natural contrast agent. The single, double and triple BS are described in view of 23 cases indicating the level of the obstruction, and its differential diagnosis is discussed. The presence of BS in the gasless abdomen of the newborn is an indication for surgery until proved otherwise. With the increasing experience by ultrasonography, this modality should be considered as the first bed-side procedure when suspecting upper gastrointestinal obstruction, and then be confirmed by radiograms.

Isolated severe renal injuries after minimal blunt trauma to the upper abdomen and flank: CT findings

Renal injuries caused by blunt abdominal trauma are common in children. Serious renal trauma is associated with insult to other organs, whereas isolated renal injuries are usually minor. We present the cases of six male children (aged 7–17 years) with major isolated renal injuries due to minimal blunt trauma to the upper adbomen and/or the flank, out of a total of 21 children admitted with renal trauma in a 5-years period. On physical examination all patients had a painful, tender abdomen and/or flank with ipsilateral bruises and ecchymosis. Hematuria, either macro (n=4) or micro (n=2), was found in all. The injuries were left-sided in five and were of a variable severity (grade III: n=2; grade IV: n=3; grade V: n=1 according to the kidney injury scale of the American Association for the Surgery of Trauma). Four children underwent nephrectomy. This small series underlines that major kidney insult can occur after a minimal blunt trauma localized to the flank or upper abdomen. Abdominal CT should be performed when clinical or laboratory findings or the mechanism of trauma suggest renal injury.

Malposition of catheters during voiding cystourethrography

Abstract The aim of this study was to report catheter malposition during voiding cystourethrography. Eight hundred forty-three voiding cystourethrography (265 males and 578 females, aged 1 week to 12 years, mean age 2 years) were performed during a period of 4 years. The conventional standard procedure was applied. In 3 cases with passed history of urinary tract infection the catheter entered directly into the ureter. In all these cases the uretero-vesical reflux was present on the same side where the catheter entered. It appears that insertion of a catheter into the ureter is possible only in the presence of an anomaly or pathology at the vesicoureteric junction.

Ileal Perforation Due to an Ingested Fragment of a Skewer Preoperative Ultrasonographic Diagnosis

Ingested foreign bodies (FBs) rarely cause gastrointestinal perforation; however, long, hard, or sharp indigestible objects remain potentially dangerous. We report a case of intestinal perforation by an ingested fragment of a wooden skewer for which ultrasonography led to a precise preoperative diagnosis.