High rates of Chlamydia trachomatis infections in young Papua New Guinean infants.

OBJECTIVE: Determine the importance of Chlamydia trachomatis in the etiology of severe infection in young Papua New Guinean infants. METHODS: Between March, 1991, and April, 1993, children <3 months old were recruited as outpatients at Goroka Base Hospital, Papua New Guinea, as part of a multicenter study in four developing countries. Children with predefined inclusion criteria were enrolled. C. trachomatis was identified by direct fluorescent antibody staining in nasopharyngeal aspirates (NPAs) collected from children with and without signs of severe disease and eye swabs from children with and without conjunctivitis. Two to three radiologists read chest radiographs without knowledge of clinical and laboratory findings. RESULTS: Of 3280 outpatients seen 2168 enrolled, 955 NPAs were tested for C. trachomatis and 549 chest radiographs were read. Of 210 eye swabs from children with conjunctivitis 57% were positive for C. trachomatis compared with 8% from 167 children with no conjunctivitis. The prevalence of C. trachomatis in NPAs was 9% in asymptomatic children and 18 and 33% in children with nonsevere or severe pneumonia, respectively. C. trachomatis in NPAs was strongly associated with clinically severe pneumonia [odds ratio (OR), 2.91], reduced arterial oxygen saturation (OR 2.58) and radiographic evidence of pneumonia (OR 5.84) and was also associated with pneumococcal bacteremia (OR 3.48). CONCLUSIONS: In Papua New Guinea Chlamydia must be considered as a cause when treating pneumonia in infants, and effective treatment and prevention of sexually transmitted diseases are urgently needed for a number of reasons, including the need to curb high rates of chlamydial infection in women and infants.

Infection with Ureaplasma urealyticum: is there a specific clinical and radiological course in the preterm infant?

BACKGROUND: Despite having mild early respiratory disease, many preterm babies develop chronic lung disease (CLD). Intrauterine infection with Ureaplasma urealyticum has been associated with preterm labour and CLD. OBJECTIVE: To test the hypothesis that infection with U urealyticum results in a specific clinical and radiological picture in the first 10 days of life. METHODS: Retrospective study of 60 ventilated babies < 30 weeks gestation, who had tracheal secretions tested for U urealyticum. Placental histology was reviewed by a paediatric pathologist for signs of chorioamnionitis. Chest radiographs were independently reviewed by two paediatric radiologists according to previously agreed criteria. All reviewers were blinded to the infection status of the babies. RESULTS: Twenty five babies were U urealyticum positive. These were more likely to experience chorioamnionitis (p = 0.004), premature rupture of membranes (p = 0.01), and spontaneous vaginal delivery (p = 0.09). U urealyticum positive babies had fewer signs of respiratory distress syndrome on early chest radiographs (p = 0.038), and they could be weaned from their ventilation settings (fraction of inspired oxygen (FIO(2)) and mean airway pressure) more quickly in the first few days. Subsequently U urealyticum positive babies deteriorated clinically and radiologically. More often they required ventilation to be restarted (p = 0.051), a higher proportion being ventilated on day 10 (p = 0.027) with higher FIO(2) (p = 0.001) and mean airway pressure (p = 0.002). Their chest radiographs showed more emphysematous changes as early as day 5 (p = 0.045), with a pronounced difference by day 10 (p = 0.009). CONCLUSIONS: Preterm ventilated babies with U urealyticum in their tracheal secretions have a different clinical and radiological course, with less acute lung disease but early onset of CLD, compared with those with negative cultures.

Colonic complication of acute lymphoblastic leukaemia.

We present four unusual colonic complications of acute lymphoblastic leukaemia which occurred during the early induction period of chemotherapy. These included a transverse colitis, a haemorrhagic proctitis, a caeco-colic intussusception and an ileo-colic intussusception complicating typhlitis. Although complications are rare, they should be considered in the differential diagnosis of abdominal pain in children undergoing chemotherapy.

Imaging of neonatal pulmonary sequestration including Doppler ultrasound.

Seven cases of neonatal pulmonary sequestration are reviewed which illustrate the varied clinical presentations and radiological findings. In four patients, real time ultrasound scanning was used to image the chest and the features are described. In three cases, the systemic supplying artery was demonstrated by duplex Doppler scanning and further invasive investigations were avoided; after a chest radiograph, this should be the examination of choice in the investigation of a neonate with a possible pulmonary sequestration.

Case report: primary intrathoracic rhabdomyosarcoma: a rare childhood malignancy.

Primary intrathoracic rhabdomyosarcoma is a rare tumour in childhood. Three cases are presented and the radiological findings and clinical course are reviewed. The radiological manifestations are varied but a rapidly growing soft tissue mass with compression of adjacent structures is the most common. A rare association with an underlying congenital pulmonary cyst is described. The prognosis is worse than for rhabdomyosarcoma at other sites, with a predisposition for cerebral metastases.

Arthrosonography of the irritable hip in childhood: a review of 1 year's experience.

A retrospective study of 87 children presenting acutely with an "irritable hip" was undertaken to assess the role of arthrosonography of the hip joint. Arthrosonography detected 52 hip-joint effusions, of which 16 were aspirated and an effusion confirmed in 14 (88%). In 82 cases plain radiography was compared with arthrosonography for the detection of hip-joint effusions. Of 47 children with a positive ultrasound diagnosis, 28 (59%) showed abnormal findings on plain radiographs and, of 35 cases with negative ultrasound findings, 22 (63%) had a negative diagnosis by plain radiography. Patients with more severe clinical signs were more likely to have an ultrasonic diagnosis of an effusion (87%-100%) than those with mild clinical signs (25%). The ultrasonic measurement of the hip-joint capsule to femoral neck distance was 2.2 mm +/- 0.5 mm (mean +/- 1 SD) in normal hips and 6.3 mm +/- 1.5 mm in the joints with effusions. Our study suggests that arthrosonographically the normal capsular space is less than 3 mm and the difference between the two sides less than 2 mm. It is suggested that hip arthrosonography is a more accurate method for detecting hip-joint effusions than plain radiography; it may help select cases for hospital admission and should be performed before aspiration is attempted.

Initial investigation of childhood urinary tract infection: does the plain abdominal X ray still have a role?

To reassess the plain abdominal X ray (AXR) in the initial investigation of childhood urinary tract infection, radiologists from four paediatric units prospectively collected data on the yield from the AXR in 683 children. Five children had renal calculi. All were detected on ultrasound, but one was not visible on the initial AXR. Four spinal abnormalities were identified, none of which prompted any action by the clinician involved. While the costs, in both financial and radiation risk terms, may be small, the benefit of the AXR appears equally small. Where expert paediatric ultrasonography is available we would recommend that the AXR be reserved for patients with haematuria, loin pain, family history of calculus disease, or where further urinary tract infection occurs despite a normal ultrasound scan.

Orogastric magnet removal of ingested disc batteries.

Ingestion of disc batteries by infants and small children is an increasing problem. Batteries that remain in the stomach can corrode and damage mucosa and/or produce poisoning. Between 1989 and 1992, 37 children who had swallowed a total of 46 disc batteries presented to the Royal Hospital for Sick Children, Edinburgh, and were referred for battery removal by use of an orogastric magnet under fluoroscopy. Thirty-nine batteries were removed successfully (without anesthesia) from 32 children, using a magnet attached to an orogastric tube. In three cases the battery had passed into the small bowel. In one case, magnet extraction failed, but the two batteries the child had ingested subsequently passed into the small bowel. In two cases the patients refused to swallow the tube. In one of these cases the battery was removed successfully by the magnet, with the patient under general anesthesia; in the other it passed spontaneously into the small bowel. The authors conclude that orogastric magnet removal is a minimally invasive, well-tolerated method of removing ingested disc batteries.

Transient synovitis: is there a need to aspirate hip joint effusions?

There is debate as to the optimal management of children with hip joint effusions especially regarding the decision to aspirate. The objective of this study was to determine whether there is a need to aspirate hip joint effusions detected on ultrasound in patients with clinical transient synovitis (TS) and to identify the natural history of these effusions. Twenty-five children with proven hip joint effusions were followed up sequentially by clinical and radiological examination until symptom free. The mean age was 6 years with equal right/left distribution. No child underwent hip aspiration and no cases of sepsis were missed. The median size of hip effusion detected on ultrasound at presentation was 9 mm. At 7 days 60% (15/25) of patients had a normal clinical examination with no detectable effusion on ultrasound. At 14 days 16% (4/25) had an effusion detectable on ultrasound but they were all pain and limp free and their effusions were reducing in size. These results support the known benign nature of TS and that it will settle with conservative treatment.

Magnetic resonance imaging of the paediatric chest.

Magnetic resonance (MR) has an important role to play in the imaging of the paediatric chest, not least because of its zero ionizing radiation dose. Computerized tomography (CT) has been the preferred technique for cross-sectional imaging to date because of the ease of access, speed and superior spatial resolution. This article discusses the clinical situations where magnetic resonance may be used as the primary cross sectional imaging modality. The clinical indications and the complimentary roles of magnetic resonance and computerized tomography are discussed. The patient preparation, technical aspects, advantages and disadvantages of MR are documented.

Observations on the use of Doppler ultrasound in multicystic dysplastic kidney.

Pulsed Doppler ultrasound was used to assess the renal artery in patients with multicystic kidney. In 7 out of 7 patients there was marked abnormality of the waveform. Doppler ultrasound may be a useful complementary diagnostic method in patients suspected of having a multicystic dysplastic kidney.

The rare association of right adrenal haemorrhage and renal vein thrombosis diagnosed with duplex ultrasound.

Neonatal adrenal haemorrhage with renal vein thrombosis, an almost exclusively left-sided phenomenon, may occasionally be bilateral in the presence of inferior vena cava thrombus but has only twice been reported as confined to the right side. These cases required a combination of ultrasound (USS), excretion urography, cystoscopy with retrograde pyelography, radioisotopes, and CT to diagnose this rare right-sided combination. We report a case of right adrenal haemorrhage causing right renal vein thrombosis accurately diagnosed using only duplex USS and radioisotopes. The potential complications of renal vein thrombosis and hypertension associated with adrenal haemorrhage requires accurate diagnosis and this paper emphasises the value of duplex USS.

The ultrasonic appearances of the septa of Bertin in children.

The ultrasonic appearances of the septa of Bertin are described in relation to eight children. These septa may be of varying echogenicity from the remaining cortex and may lead to a misdiagnosis of a true pathological lesion. In our series, two children had an initial suspicion of an abdominal mass; one an intrarenal neoplasm and the other an intrarenal haematoma. It is of importance to recognise this normal variation to avoid misdiagnosis of a pathological mass and to avoid further unnecessary investigation.

Evaluation of long-term central venous patency in children with chronic venous catheters using image-directed Doppler ultrasonography.

All children in the Oncology Unit in the Royal Hospital for Sick Children, Edinburgh who had had long-term central venous catheters removed between 1987 and 1991 underwent central venous assessment by image-directed Doppler ultrasound scanning techniques. In this study, the implant vein remained patent after decannulation, and we believe should be re-accessed rather than moving to another site.