Pubic osteomyelitis.

A case of pubic osteomyelitis in a child is presented. A well localized hyperactive area on a Tc-99m MDP bone scan provided the correct diagnosis. This scintigraphic localization of osteomyelitis seldom has been reported.

Congenital toxoplasmosis after maternal infection before or slightly after conception.

We report a newborn with typical lesions of congenital toxoplasmosis. Retrospectively, the time of infection could be located to or even before conception. A diagnostic work-up should be performed in every newborn whose mother presents persistent high antibody titers against toxoplasma during pregnancy.

Muscular injury in a child diagnosed by 99mTc-MDP bone scan.

An 11-year-old boy had bone scanning to rule out an osseous lesion of the right arm. He presented progressive pain and hard swelling of the right arm. His past medical history and general physical examination were unremarkable. He trained for karate. The scan demonstrated considerable muscular uptake in both arms. CPK and CPK MB levels were both abnormally high, suggesting muscle injury. After a 10-day rest period the bone scan returned to normal.

Functional taping of fractures of the 5th metacarpal results in a quicker recovery.

Fractures of the fifth metacarpal can be treated non-operatively by plaster immobilisation or functional taping. In order to evaluate the better treatment policy, the two methods were compared in a prospective randomised series. We treated 25 patients with an ulnar gutter plaster-cast splintage and 25 with functional tape. Functional recovery was evaluated after one week and four weeks, three months and six months. Mobility, power-grip, pulling- and torque strengths were measured. The change in fracture angulation was calculated at the one and four-week follow-up. Residual symptoms were evaluated after six months. The functional tape group showed significant earlier functional recovery. After six months, there were no significant differences between the groups with regard to functional and anatomical results or the number of patients with residual symptoms. In both groups, we noted a change in fracture angulation only in those fractures that had been reduced. We conclude that fractures of the 5th metacarpal are better treated by functional taping than by cast immobilisation.

First microangiographic abnormalities in childhood diabetes--types of lesions.

An analysis by fluorescein angiography of the first signs of retinopathy in 161 diabetic children showed that microaneurysm-like spot dilatations, microaneurysms, focal capillary dilatations, leakage, generalized capillary dilatations, retinal hemorrhages, areas of capillary non-perfusion and capillary remodelling, in decreasing order of frequency, were features of the onset of retinopathy. However, microaneurysm-like spot dilatations and both focal and generalized capillary dilatations were considered to be too subjective for use in further quantitative analysis. Retinopathy was not found in children less than 12 years of age and was detected only after at least 3 years of diabetes. The mean duration of diabetes before the occurrence of the first lesions in 118 affected eyes was 8.2 years. The mean age at which lesions occurred was 16.4 years. Although capillary non-perfusion was rarely an initial lesion, occurring after a longer duration of diabetes and at a later age than the other lesions, no significant difference could be found between the various types of lesions for either the patient's age at their onset or the duration of diabetes. The type of initial lesion was also unrelated to sex, age at the onset of diabetes, or metabolic control.

Two automated fully enzymatic assays for lipase activity in serum compared: positive interference from post-heparin lipase activity.

The fully enzymatic Wako and Ektachem assays for pancreatic lipase in serum were found to yield precise (especially Ektachem) and consistent results that were significantly correlated (r = 0.995). Less good concordance was found with the turbidimetric aca method, results being on several occasions above normal by Wako or Ektachem but within the reference limit by the aca. Supplementation of aca packs with colipase generally increased lipase activities measured by the aca in these samples, thereby improving the correlation with Wako and Ektachem. In vitro addition experiments documented that both Wako and Ektachem were relatively insensitive to common chemical interferences. However, post-heparin lipase activities produced a positive interference in both assays, resulting in seemingly increased lipase activities that were suggestive of pancreatic disease. Substituting sodium glycocholate (6 mmol/L) for deoxycholic acid largely eliminated this positive interference in the Wako assay. Because Ektachem reagents cannot be modified in this way, we added sodium glycocholate (2-12 mmol/L) to sera; however, this failed to dissipate the in vivo effect of heparin on the Ektachem results.

Limitations in the use of indium-111-oxine-labeled leucocytes for the diagnosis of occult infection in children.

Fifteen children underwent scintigraphy with indium 111 (111In)-labeled white blood cells (WBC) for the detection of a local suppuration. The procedure generally contributed to a correct diagnosis. False negative results were observed in 5 children, but in two of them positive foci were also present. The missed lesions were 2 liver abscesses, 1 lung abscess, foci of osteomyelitis and 1 pericarditis. Two cases of chronic granulomatous disease are presented in which increased leucocyte accumulation was not observed in proven instances of infection.