Tuberculosis of the ankle in childhood: clinical, roentgenographic and computed tomography findings.

We report on three Italian children who presented with unilateral ankle tuberculosis (TB) consecutively during a short time period and in the same geographical area. A 6-year-old-girl with a family history of TB had limited mobility of the right leg at age 9 months; Mantoux test and radiographs at that age yielded normal findings. When severe right tibiotarsal swelling, reddening, pain and restriction of motion became apparent at age 4.6 years, the typical lesions of TB were evident on radiographs and computed tomographic (CT) scans. Mantoux test and synovial biopsy confirmed TB. A three-drug regimen of treatment proved useless: articular cartilage destruction and diffuse osteosclerosis ensued. Only a four-drug prolonged regimen of treatment proved to be somewhat effective. A 5-year-old girl had a 6-month history of painless swelling and limited mobility of the ankle; radiographs and CT showed osteopenia with marginal erosion of cartilages. A 14-month-old boy presented with a 2-week history of painless swelling ankle. Radiographs showed decreased bone density of talocalcanear bones. Mantoux test and synovial biopsy confirmed TB in both patients; treatment with a three-drug regimen greatly reduced symptoms. A careful suspicion of the diagnosis of tuberculosis is paramount in children with chronic or subacute monoarticular arthritis, even in absence of a positive tuberculin test or abnormalities on chest radiograph. When negative early on, the tuberculin test should be repeated after 6 weeks of arthritis, and a needle biopsy of the synovium is required in those children with monoarticular arthritis and a positive tuberculin test. Careful therapy is necessary to avoid sequelae that may lead to severe osteoarticular damage.

[Genetic role in hernia of the esophageal hiatus. Description of the disease in 2 brothers]. / Ruolo genetico nelle ernie dello jatus esofageo. Descrizione dell'affezione in due fratelli.

Two brothers born 15 years apart from normal healthy parents were affected by esophageal hiatus hernia diagnosed at 4 and 8 months respectively. We found 37 other families with more than one member affected by EHH reported in the literature. Since the anomaly often runs asymptomatic, familiarity is probably more frequent than generally thought. The type of inheritance is still uncertain, but a multifactorial etiology is the most likely explanation.

[Congenital hip dysplasia in Sicily]. / La displasia congenita dell'anca in Sicilia.

The Authors have analyzed the results of the ultrasound exams of the hips made in the Department of Pediatric Radiology, of the Catania University between 1993-1996 on 2000 little patients aged from 0 to 7 months. The aim of the examination was to define the frequency of the congenital dysplasia of the hip among the population of South-East Sicily because in literature there are no sure data. After a keen analysis of these data one can affirm that the incidence of the congenital dysplasia of the hip among the population of South-East Sicily is of 2.55% with the overwhelming prevalence in the females (M/F = 1/5). This percentage is thus comparable to the national one, and this allow us to confirm the great importance of the mass screening to prevent the congenital dysplasia of the hip even in Sicily.

[Congenital pulmonary lymphangiectasia with chylothorax. Different evolution of 2 cases with severe neonatal respiratory distress]. / Linfangectasia polmonare congenita con chilotorace. Differente evoluzione di due casi con grave distress respiratorio neonatale.

The Authors report on 2 cases of congenital pulmonary lymphangiectasia with chylothorax and severe respiratory distress which were characterized by a different clinic course. One of the newborns, in fact, died after a few days of life, while the other has survived with the complete regression of chylothorax. The Authors also add some physiopathologic remarks about pulmonary lymphatic circulation, in order to focus the different evolution of the 2 cases and the pulmonary lymphangiectasia treatment.

Imaging of urinary tract malformations: intravenous urography and/or kidney ultrasonography?

We performed both kidney ultrasonography (KUS) and intravenous urography (IVU) in 56 children with urinary tract infections (UTI) to compare the effectiveness of these procedures in detecting urinary tract malformations (UTMs). In 7 patients where KUS findings were interpreted as normal, IVU detected the following UTMs: hydronephrosis (3), stenosis of the pelvi-ureteric junction (2), pelvi-ureteric duplication (1) and kidney dislocation (1). In 2 other patients, mild hydronephrosis diagnosed by KUS was not confirmed by IVU. With respect to IVU, KUS revealed a sensitivity of 77.4% and a specificity of 92%. In our experience, IVU is still irreplaceable in the diagnostic protocol of UTMs in children; KUS should be regarded as a useful complementary procedure.