validity of ultrasound in diagnosing hypertrophic pyloric stenosis

To evaluate the validity of ultrasound for diagnosis and exclusion of pyloric stenosis in the infants with nonbilious vomiting. In a cross-sectional study, 444 consecutive infants with clinical suspicion of pyloric stenosis were evaluated by ultrasound [US] and categorized as pyloric stenosis or not according measuring parameters as muscle thickness, muscle width and canal length of pylorus. Positive findings were confirmed at surgery; Negative findings were confirmed by means of follow up. Sensitivity, specificity and accuracy were calculated. Sensitivity, specificity and accuracy of ultrasound were 100% if pyloric muscle thickness of >3mm was chosen as diagnostic. When muscle thickness more than 4mm was used, sensitivity, specificity and accuracy were 96%, 100% and 99.32% respectively. Ultrasound is highly sensitive and specific if pyloric muscle thickness 3 mm is used as cut off point. By virtue of direct visualization of the pyloric muscle, ultrasound is method of choice for both the diagnosis and exclusion of pyloric stenosis in infants

Ceftriaxone induced biliary pseudolithiasis in children: report of 14 cases

Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy. In this study we evaluated children with ceftriaxone associated pseudolithiasis that was discovered incidentally in US examination. The study includes 14 children with gallstones in Ultrasound without biliary symptoms with recent ceftriaxone administration. All of them were treated for suspected or definite bacterial infection with ceftriaxone 50-100mg/kg/day divided into 2 equal intravenous doses under conditions of adequate hydration. There were no other known underlying diseases for gallstone. Fourteen patients [11 boys and 3 girls] with mean age of 4.5 years [range: 2 months to 14 years] were studied. Following cessation of treatment with ceftriaxone, a complete resolution of the lithiasis was seen in most of followed cases. All patients were free from biliary symptoms [Right upper quadrant pain, Cholestasis] during observation. Consultations with surgeon or subspecialist due to reported "gallstone in the Ultrasound" were performed in about two-thirds of patients. Development of pseudolithiasis after ceftriaxone administration is not uncommon and should be known by pediatricians and radiologists in order to avoid unnecessary surgery or additional consultations