Bacterial osteomyelitis in pediatric patients: a comprehensive review.

Bacterial osteomyelitis, an inflammatory response in the bone caused by microorganisms, typically affects the metaphysis in the skeletally immature. Bacterial osteomyelitis possesses a significant diagnostic challenge in pediatric patients due to its nonspecific clinical presentation. Because the metaphysis is the primary focus of infection in skeletally immature patients, understanding the normal physiologic, maturation process of bones throughout childhood allows to understand the pathophysiology of osteomyelitis. Timely and accurate diagnosis is crucial to initiate appropriate treatment, and prevent long-term sequelae and efforts must be made to isolate the causative organism. The potential causative organism changes according to the age of the patient and underlying medical conditions. Staphylococcus Aureus is the most common isolated bacteria in pediatric pyogenic osteomyelitis whereas Kingella Kingae is the most common causative agent in children aged 6 months to 4 years. Imaging plays a pivotal role in the diagnosis, characterization, evaluation of complications, and follow up of bacterial osteomyelitis. Imaging also plays a pivotal role in the evaluation of potential neoplastic and non-neoplastic mimickers of osteomyelitis. In children, MRI is currently the gold standard imaging modality when suspecting bacterial osteomyelitis, whereas surgical intervention may be required in order to isolate the microorganism, treat complications, and exclude mimickers.

Large variation in radiation dose for routine abdomen CT: reasons for excess and easy tips for reduction.

OBJECTIVE: To characterize the use and impact of radiation dose reduction techniques in actual practice for routine abdomen CT. METHODS: We retrospectively analyzed consecutive routine abdomen CT scans in adults from a large dose registry, contributed by 95 hospitals and imaging facilities. Grouping exams into deciles by, first, patient size, and second, size-adjusted dose length product (DLP), we summarized dose and technical parameters and estimated which parameters contributed most to between-protocols dose variation. Lastly, we modeled the total population dose if all protocols with mean size-adjusted DLP above 433 or 645 mGy-cm were reduced to these thresholds. RESULTS: A total of 748,846 CTs were performed using 1033 unique protocols. When sorted by patient size, patients with larger abdominal diameters had increased dose and effective mAs (milliampere seconds), even after adjusting for patient size. When sorted by size-adjusted dose, patients in the highest versus the lowest decile in size-adjusted DLP received 6.4 times the average dose (1680 vs 265 mGy-cm) even though diameter was no different (312 vs 309 mm). Effective mAs was 2.1-fold higher, unadjusted CTDIvol 2.9-fold, and phase 2.5-fold for patients in the highest versus lowest size-adjusted DLP decile. There was virtually no change in kV (kilovolt). Automatic exposure control was widely used to modulate mAs, whereas kV modulation was rare. Phase was the strongest driver of between-protocols variation. Broad adoption of optimized protocols could result in total population dose reductions of 18.6-40%. CONCLUSION: There are large variations in radiation doses for routine abdomen CT unrelated to patient size. Modification of kV and single-phase scanning could result in substantial dose reduction. CLINICAL RELEVANCE: Radiation dose-optimization techniques for routine abdomen CT are routinely under-utilized leading to higher doses than needed. Greater modification of technical parameters and number of phases could result in substantial reduction in radiation exposure to patients. KEY POINTS: • Based on an analysis of 748,846 routine abdomen CT scans in adults, radiation doses varied tremendously across patients of the same size and optimization techniques were routinely under-utilized. • The difference in observed dose was due to variation in technical parameters and phase count. Automatic exposure control was commonly used to modify effective mAs, whereas kV was rarely adjusted for patient size. Routine abdomen CT should be performed using a single phase, yet multi-phase was common. • kV modulation by patient size and restriction to a single phase for routine abdomen indications could result in substantial reduction in radiation doses using well-established dose optimization approaches.

Pediatric hand ultrasound: common indications, injury, inflammation and masses.

Ultrasound is a uniquely valuable tool for evaluating musculoskeletal problems in the pediatric hand. Acute and chronic injuries involving tendons and ligaments of the hand can be quickly assessed and can guide surgical decision-making. Using ultrasound, palpable lesions and masses can be evaluated for cystic and solid components aiding in differential diagnosis. Additionally, ultrasound provides evaluation of acute versus chronic changes of inflammatory arthritis, assessing disease severity and subclinical synovitis and serving as an adjunct to medical management. This review will cover common indications and ultrasound findings of the pediatric hand, focusing on common injuries, inflammatory arthritis and masses. Important anatomical features of the hand will be discussed as well as imaging technique and evaluation in the pediatric patient.

Diagnostic reference levels and median doses for common clinical indications of CT: findings from an international registry.

OB JECTIVES: The European Society of Radiology identified 10 common indications for computed tomography (CT) as part of the European Study on Clinical Diagnostic Reference Levels (DRLs, EUCLID), to help standardize radiation doses. The objective of this study is to generate DRLs and median doses for these indications using data from the UCSF CT International Dose Registry. METHODS: Standardized data on 3.7 million CTs in adults were collected between 2016 and 2019 from 161 institutions across seven countries (United States of America (US), Switzerland, Netherlands, Germany, UK, Israel, Japan). DRLs (75th percentile) and median doses for volumetric CT-dose index (CTDIvol) and dose-length product (DLP) were assessed for each EUCLID category (chronic sinusitis, stroke, cervical spine trauma, coronary calcium scoring, lung cancer, pulmonary embolism, coronary CT angiography, hepatocellular carcinoma (HCC), colic/abdominal pain, appendicitis), and US radiation doses were compared with European. RESULTS: The number of CT scans within EUCLID categories ranged from 8,933 (HCC) to over 1.2 million (stroke). There was greater variation in dose between categories than within categories (p < .001), and doses were significantly different between categories within anatomic areas. DRLs and median doses were assessed for all categories. DRLs were higher in the US for 9 of the 10 indications (except chronic sinusitis) than in Europe but with a significantly higher sample size in the US. CONCLUSIONS: DRLs for CTDIvol and DLP for EUCLID clinical indications from diverse organizations were established and can contribute to dose optimization. These values were usually significantly higher in the US than in Europe. KEY POINTS: • Registry data were used to create benchmarks for 10 common indications for CT identified by the European Society of Radiology. • Observed US radiation doses were higher than European for 9 of 10 indications (except chronic sinusitis). • The presented diagnostic reference levels and median doses highlight potentially unnecessary variation in radiation dose.

Breast development in pediatric patients from birth to puberty: physiology, pathology and imaging correlation.

Breast tissue undergoes a series of changes from birth to puberty. The majority of the changes are transient, related to physiological hormonal changes. Although the breast is identical in both sexes at birth, its histology and development will eventually differ. It is important for radiologists to have a basic understanding of endocrinological changes and appearance on imaging to avoid potential pitfalls, particularly on ultrasound, which is the primary modality used to evaluate the breast.

Estado del conocimiento de la historiografía de la educación en Tamaulipas siglo XIX / State of knowledge of 19th Century higher education historiography in Tamaulipas

Resumen El estado de Tamaulipas está ubicado al noreste de México, región geográfica colonizada años más tarde que el centro y el sur del país. Se ha documentado poco del devenir histórico de las primeras instituciones educativas del nivel superior de la entidad. El objetivo del presente trabajo fue presentar el estado actual que guarda el conocimiento de la historiografía de la educación en Tamaulipas del siglo XIX. Se localizaron 22 obras editadas y publicadas entre 1948 y 2018, que recogieron las memorias y experiencias educativas. Se sometieron a un procedimiento, con base en criterios historiográficos, que permitió ordenarlas en historias, biografías, crónicas o memorias. Se agruparon en correspondencia a espacios y temporalidades, en generales o regionales y por periodos históricos. Se describen las obras que hablan de las dos etapas: la inicial, referente a la fundación de las primeras instituciones por maestros republicanos ilustrados; escritas por sus egresados, historiadores por vocación, autores de las primeras historias de la educación estatal, que trabajaron en un marco ilustrado, liberal, republicano y juarista, promotor de ofrecer al pueblo una educación pública, laica, gratuita y obligatoria, en el que quedó institucionalizada la educación superior del estado. La segunda etapa ocurre en el siglo XX, con la creación de la Universidad de Tamaulipas, que sería después la Universidad Autónoma de Tamaulipas, institución que permite formar historiadores de profesión, maestros e historiadores de raigambre decimonónica, que complementan el marco histórico educativo. Este trabajo permite un punto de partida al investigador interesado en continuar con la línea de la historia e historiografía de este tiempo y espacio.

Abstract The state of Tamaulipas is located in the northeast geographical region of Mexico, which was colonized several years after the center and south of the country. Little has been documented of the historical evolution of the first higher education institutions of the state. The aim of this work is to show the current state of knowledge of the historiography of education in Tamaulipas in the 19th century. Twenty-two edited and published works, which collected memories and educational experiences between 1948 and 2018 were found. They underwent a procedure, based on historiographic criteria, which allowed their classification into histories, biographies, chronicles, or memoirs. They were grouped according to spaces and temporalities in general or regional, and by historical periods of education. The works that discuss each of the stages are described as follows: those of the initial stage, referring to the founding of the first institutions by illustrated republican teachers were written by its graduates, historians by vocation, authors of the first histories of state education, who worked within an enlightened, liberal, republican and juarista framework, promoter of offering the people a public, secular, free and compulsory education, in which higher education in the state was institutionalized. The second stage occurred in the 20th century, with the creation of the University of Tamaulipas, which would later become the Universidad Autónoma de Tamaulipas, an institution that educates professional historians, history teachers and historians of nineteenth-century roots, which complement the historical educational framework. This work provides a starting point for the researcher who is interested in continuing with the line of history and historiography of this time and space.

Comparison of the Effectiveness of Single-Component and Multicomponent Interventions for Reducing Radiation Doses in Patients Undergoing Computed Tomography: A Randomized Clinical Trial.

Importance: Computed tomography (CT) radiation doses vary across institutions and are often higher than needed. Objective: To assess the effectiveness of 2 interventions to reduce radiation doses in patients undergoing CT. Design, Setting, and Participants: This randomized clinical trial included 864 080 adults older than 18 years who underwent CT of the abdomen, chest, combined abdomen and chest, or head at 100 facilities in 6 countries from November 1, 2015, to September 21, 2017. Data analysis was performed from October 4, 2017, to December 14, 2018. Interventions: Imaging facilities received audit feedback alone comparing radiation-dose metrics with those of other facilities followed by the multicomponent intervention, including audit feedback with targeted suggestions, a 7-week quality improvement collaborative, and best-practice sharing. Facilities were randomly allocated to the time crossing from usual care to the intervention. Main Outcomes and Measures: Primary outcomes were the proportion of high-dose CT scans and mean effective dose at the facility level. Secondary outcomes were organ doses. Outcomes after interventions were compared with those before interventions using hierarchical generalized linear models adjusting for temporal trends and patient characteristics. Results: Across 100 facilities, 864 080 adults underwent 1 156 657 CT scans. The multicomponent intervention significantly reduced proportions of high-dose CT scans, measured using effective dose. Absolute changes in proportions of high-dose scans were 1.1% to 7.9%, with percentage reductions in the proportion of high-dose scans of 4% to 30% (abdomen: odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P < .001; chest: OR, 0.92; 95% CI, 0.86-0.99; P = .03; combined abdomen and chest: OR, 0.49; 95% CI, 0.41-0.59; P < .001; and head: OR, 0.71; 95% CI, 0.66-0.76; P < .001). Reductions in the proportions of high-dose scans were greater when measured using organ doses. The absolute reduction in the proportion of high-dose scans was 6.0% to 17.2%, reflecting 23% to 58% reductions in the proportions of high-dose scans across anatomical areas. Mean effective doses were significantly reduced after multicomponent intervention for abdomen (6% reduction, P < .001), chest (4%, P < .001), and chest and abdomen (14%, P < .001) CT scans. Larger reductions in mean organ doses were 8% to 43% across anatomical areas. Audit feedback alone reduced the proportions of high-dose scans and mean dose, but reductions in observed dose were smaller. Radiologist's satisfaction with CT image quality was unchanged and high during all periods. Conclusions and Relevance: For imaging facilities, detailed feedback on CT radiation dose combined with actionable suggestions and quality improvement education significantly reduced doses, particularly organ doses. Effects of audit feedback alone were modest. Trial Registration: ClinicalTrials.gov Identifier: NCT03000751.

Alternancia política atípica en el municipio de Abasolo, Tamaulipas (1980-1983) / Atypical political alternation in the municipality of Abasolo, Tamaulipas (1980-1983)

RESUMEN El entrelazamiento de las convicciones ideológicas de la juventud del Partido Socialista de los Trabajadores (PST) en México y la experiencia victoriosa del reparto agrario con la fundación de los Nuevos Centros de Población Ejidal (NCPE), en el municipio de Abasolo, Tamaulipas, México, de los campesinos agrupados en Comités Ejecutivos Particulares Agrarios (CPEA), dieron lugar a la primera alternancia municipal de la historia contemporánea de Tamaulipas. El ayuntamiento fue reconocido constitucionalmente en 1983, siendo la única victoria electoral del PST en el estado. El objetivo de este trabajo fue documentar los antecedentes sobre la historia política y social del Partido Socialista de los Trabajadores (PST) de 1980 a 1983. El procedimiento de esta investigación fue histórica, con base en la triangulación de fuentes primarias y secundarias, siguiendo la premisa de que la política es la continuación de la guerra por otros medios. La historia del rompimiento de la hegemonía del Partido Revolucionario Institucional (PRI), en Abasolo, fue recreada con archivos históricos y entrevistas orales de diferentes actores sociales de la época. El PST alcanzó el reconocimiento constitucional del ayuntamiento en 1983 por 21 días, por lo que se dio una alternancia municipal atípica. Esta alternancia, resultó ser atípica no sólo por el hecho de que un partido distinto y de reciente creación ganara las elecciones, sino por las condiciones en las que se eligió el candidato y se dio el proceso electoral municipal, así como el modo en que el presidente municipal concluyó el periodo constitucional. Dichos sucesos posibilitaron la lucha político-electoral entre el PST y el Partido Revolucionario Institucional (PRI) en ese municipio.

ABSTRACT The interlacing between the ideological convictions of the Socialist Workers Party (SWP) youth in Mexico, the victory of land distribution among the New Ejido Population Settlements (Nuevos Centros de Población Ejidal, NCPE), and the organization of farmers in Particular Executive Committees of Agriculture (Comités Ejecutivos Particulares Agrarios, CEPA), resulted in the first political alternation contemporary history of Tamaulipas, which took place in Abasolo municipality. The city council was constitutionally recognized in 1983, being the only electoral victory of the SWP in the state. The objective of this paper is to record the background of the political and social history of the SWP from 1980 to 1983. This was a historical research based on the triangulation of primary and secondary sources, following the assumption that politics is the prolongation of the war by other means. The history of the hegemony of the Institutional Revolutionary Party's (Partido Revolucionario Institucional, PRI) breakdown in Abasaolo was recreated through historical archives and oral interviews with different social actors of the time. The SWP achieved constitutional recognition from the city council in 1983 during 21 days, representing an atypical political alternation in the municipality. This alternation was atypical not only because a different party was elected, but also due to the conditions in which the electing process was conducted, how the elected candidate was chosen, and the manner in which the city mayor concluded the constitutional period. These events made the political struggle between the SWP and the PRI possible in this municipality.

Neonatal diagnosis of a patient with hypoparathyroidism, sensorineural deafness and renal dysplasia (HDR) syndrome associated with cerebral infarction.

Hypoparathyroidism, sensorineural deafness and renal dysplasia syndrome (HDRS) is comprised of a triad of conditions. It is an autosomal dominant condition caused by mutations in the GATA3 gene, located at 10p15, a critical region in the development of the embryonic parathyroid glands, inner ear, and kidneys. Here we describe the case of a patient with all three components of HDR syndrome diagnosed in the neonatal period who presented with cerebral infarction, hypocalcemia, and renal anomalies. Upon chromosomal microarray he was found to have an interstitial deletion at 10p, which produced a partial deletion in the GATA3 gene.

Elevated alpha-fetoprotein levels in Van Wyk-Grumbach syndrome: a case report and review of literature.

The association between primary hypothyroidism and precocious puberty secondary to ovarian hyperstimulation has been recognized for over a century. Here, we report the case of a 9-year-old girl with severe primary hypothyroidism, who presented with premature menarche, enlarged pituitary gland, enlarged ovaries with multiple cysts, and elevated prolactin and alpha-feto protein levels. Pituitary and ovarian radiology findings, and alpha-feto protein levels normalized a few weeks after hypothyroidism treatment was started. Reviewing the literature we found several reports of increased levels of tumor markers in girls with this association. Thyroid function tests should be always part of the evaluation of patients with precocious puberty especially if the bone age is delayed. Tumor markers and liver function tests may be abnormal in patients with severe hypothyroidism and improve soon after thyroid hormone replacement is started.

Hemangiomas revisited: the useful, the unusual and the new. Part 1: overview and clinical and imaging characteristics.

Hemangiomas are common vascular tumors occurring in children. Though most of the lesions present in infants and young children with a typical appearance, it is important to understand that they all do not behave in the same way. Rather, they are a group of vascular lesions with different clinico-pathological subtypes, with their clinical behavior varying with the stage of the tumor as well. As such, they can and do have a varied clinical, imaging and pathological appearance according to the location of the tumor and also the stage at which the patient is seen. In this pictorial essay, the classification, pathogenesis, clinical appearance, natural history and imaging characteristics of hemangiomas are reviewed and illustrated.

Hemangiomas revisited: the useful, the unusual and the new. Part 2: endangering hemangiomas and treatment.

Hemangiomas, although benign tumors, can when located in particular regions threaten vital structures or in certain clinical circumstances be associated with other abnormalities, carrying significant morbidity and mortality. We review these endangering hemangiomas. We also discuss briefly the treatment with emphasis on the recent use of propranolol.

Desmoplastic fibroma of the pediatric skull. Report of three cases.

Desmoplastic fibromas are rare bone tumors that have been reported in the adult skull but rarely in that of children. Although desmoplastic fibromas of the pediatric skull are uncommon, their similarity to benign skull lesions and their locally aggressive nature make them an important part of the differential diagnosis. Local recurrence is common after curettage alone but complete resection appears to be curative. Close follow up of incompletely resected lesions is essential. The authors detail three cases of pediatric desmoplastic fibromas of the skull and discuss diagnosis and treatment.

Seizure disorders: functional MR imaging for diagnostic evaluation and surgical treatment--prospective study.

PURPOSE: To prospectively evaluate effect of functional magnetic resonance (MR) imaging on diagnostic work-up and treatment planning in patients with seizure disorders who are candidates for surgical treatment. MATERIALS AND METHODS: Institutional review board approval was obtained; informed consent was obtained either from the patient or the parent or guardian in all patients. This study was conducted with Health Insurance Portability and Accountability Act compliance. Sixty consecutively enrolled patients (33 males, 27 females; mean age, 15.8 years +/- 8.7 [standard deviation]; range, 6.8-44.2 years) were prospectively examined. Forty-five (75%) patients were right handed, nine (15%) were left handed, and six (10%) had indeterminate hand dominance. Prospective questionnaires were used to evaluate diagnostic work-up, counseling, and treatment plans of the seizure team before and after functional MR imaging. Confidence level scales were used to determine effect of functional MR imaging on diagnostic and therapeutic thinking. Paired t test and 95% confidence interval analyses were performed. RESULTS: In 53 patients, language mapping was performed; in 33, motor mapping; and in seven, visual mapping. The study revealed change in anatomic location or lateralization of language-receptive (Wernicke) (28% of patients) and language-expressive (Broca) (21% of patients) areas. Statistically significant increases were found in confidence levels after functional MR imaging in regard to motor and visual cortical function evaluation. In 35 (58%) of 60 patients, the seizure team thought that functional MR imaging results altered patient and family counseling. In 38 (63%) of 60 patients, functional MR imaging results helped to avoid further studies, including Wada test. In 31 (52%) and 25 (42%) of 60 patients, intraoperative mapping and surgical plans, respectively, were altered because of functional MR imaging results. In five (8%) patients, two-stage surgery with extra-operative direct electrical stimulation mapping was averted, and resection was accomplished in one stage. In four (7%) patients, extent of surgical resection was altered because eloquent areas were identified close to seizure focus. CONCLUSION: Functional MR imaging results influenced diagnostic and therapeutic decision making of the seizure team; results indicated language dominance changed, confidence level in identification of critical brain function areas increased, patient and family counseling were altered, and intraoperative mapping and surgical approach were altered.