[Acute osteomyelitis in young children--a diagnostic challenge]. / Akutt osteomyelitt hos små barn--en diagnostisk utfordring.

BACKGROUND: Acute osteomyelitis in young children poses a diagnostic challenge. Signs and symptoms are often not well defined and blood tests (SR, CRP etc.) are often of limited value. Standard roentgenograms do not preclude the diagnosis. MATERIALS AND METHODS: We present eight cases of acute osteomyelitis in children under the age of two, seen at the Child Centre, at Ullevaal University Hospital during the last year. RESULTS: Scintigraphic interpretation failed to reveal the diagnosis in two cases. Magnetic resonance imaging (MRI) was shown to be a more reliable method. Only a few biopsies were done. INTERPRETATION: Examination of children suspected of suffering from an osteomyelitis should include both a bone scintigraphy, MRI, and to the extent possible a needle biopsy.

[Endoscopic treatment of vesicoureteral reflux in children]. / Endoskopisk behandling av vesikoureteral refluks hos barn.

In the five-year period 1990-95, 102 patients, 78 girls and 24 boys, aged ten weeks to 14 years were treated for grade III-V vesicoureteral reflux by the same surgeon using subureteric teflon injection--the STING procedure. Both primary, secondary and complex reflux were included. The reflux had disappeared in 90 of 133 refluxing ureters, the grade of reflux had diminished in 17 and were unchanged in 26 at the control three months after treatment. After re-STING in 22 reflux ureters, reflux disappeared in 13, was reduced in six and unchanged in three. Reappearance of low grade reflux was seen in eight of 88 ureters between the three months and one year control, but only one needed re-STING. Open surgery was performed in 13 patients (18 reflux ureters) because of unchanged reflux after STING, most of them due to complex reflux: duplex ureters, ectopic ureters, ureteroceles and paraureteral diverticula. It is concluded that most patients with vesicoureteral reflux can be successfully treated by using subureteric teflon injection.

[Endoscopic treatment of vesicoureteral reflux in children]. / Endoskopisk behandling av vesikoureteral refluks hos barn.

In the five-year period 1990-95, 102 patients, 78 girls and 24 boys, aged ten weeks to 14 years were treated for grade III-V vesicoureteral reflux by the same surgeon using subureteric teflon injection--the STING procedure. Both primary, secondary and complex reflux were included. The reflux had disappeared in 90 of 133 refluxing ureters, the grade of reflux had diminished in 17 and were unchanged in 26 at the control three months after treatment. After re-STING in 22 reflux ureters, reflux disappeared in 13, was reduced in six and unchanged in three. Reappearance of low grade reflux was seen in eight of 88 ureters between the three months and one year control, but only one needed re-STING. Open surgery was performed in 13 patients (18 reflux ureters) because of unchanged reflux after STING, most of them due to complex reflux: duplex ureters, ectopic ureters, ureteroceles and paraureteral diverticula. It is concluded that most patients with vesicoureteral reflux can be successfully treated by using subureteric teflon injection.

MR urography in children: current status and future development.

The normal anatomy and many pathologies of the pediatric genitourinary system can be assessed with different imaging modalities. Most of them are based on the use of ionizing radiation and/or invasive techniques. The contribution of magnetic resonance imaging in this regard has opened new ways of approaching pathological conditions in this patient group. The addition of the newly developed rapid techniques has enhanced the superiority of MRI, and both morphological and functional evaluation of the genitourinary system can be achieved. There are different factors on which rely the optimization and the efficiency of magnetic resonance urography (MRU). Of importance is adequate patient immobilization and the use of optimal imaging sequences. The rapid technical development, including the advent of the post-processing respiratory navigator, allows acquisition of high-quality images independent of the patient's respiratory rate. In the future, it is expected that MRU, due to its non-use of ionizing radiation, will become the most important tool in the diagnostic work-up of genitourinary pathologies in infants and small children.

MR urography: the future gold standard in paediatric urogenital imaging?

BACKGROUND: Examination of the paediatric urogenital tract is traditionally performed using methods that utilise ionising radiation, such as intravenous urography (IVU), computerised tomography (CT), voiding cystourethrography (VCU), and scintigraphy, in addition to ultrasound (US). OBJECTIVE: To determine the potential and effectiveness of MR urography (MRU) in infants and children. Materials and methods. 44 MRU examinations were prospectively performed in 39 patients (21 infants, mean age 3.5 months, and 18 children, mean age 6 years 2 months) with known or suspected pathology of the urinary tract. Non-enhanced, fast spin-echo sequences (TSE) were performed in all patients. In 70 % of the patients a contrast-enhanced, fast gradient-echo sequence (TFE) was included. The dynamic sequence was prolonged and supplemented with furosemide provocation in some patients with suspected urinary-tract obstruction. RESULTS: Nine percent of examinations were non-diagnostic or interrupted due to movement. MRU contributed additional information in 66 %. Nine patients with suspected urinary-tract obstruction were examined with both contrast-enhanced MRU and scintigraphy. Three MRU examinations were less informative and one equal to scintigraphy when obstruction was the diagnosis. When using a technique with a prolonged dynamic sequence, including frusemide provocation, four MRU examinations were equal and one was superior to scintigraphy. CONCLUSIONS: MRU has the potential to replace traditional diagnostic methods which use ionising radiation in paediatric patients. Further studies are needed before definite conclusions can be drawn.

Lipoblastoma: MRI appearances of a rare paediatric soft tissue tumour.

Lipoblastoma is a rare, benign soft-tissue tumour derived from embryonic fat. Four patients with tumours located in the upper limb are reported, with special reference to imaging techniques and histology. Radical surgical excision is essential to prevent local recurrence and exact imaging techniques are thus crucial. MRI appears to be a reliable preoperative investigation and is the recommended radiological examination. In a child under 3 months of age, images showing a predominantly fatty but inhomogeneous soft-tissue mass are suggestive of lipoblastoma.

Severe craniofacial malformations and deglutition dysfunction in a brother and sister: new syndrome?

We report seemingly unique craniofacial malformations and deglutition dysfunction in a sib pair. The boy had right maxillomandibular alveolar synechae, ankylosis of right temporomandibular joint, hypoplasia of the zygomatico-maxillary region, nasal deviation to the left, choanal stenosis, and exophthalmos due to shallow orbita. His ears were apparently low-set with prominent lobules. He had severe gastroesophageal reflux and increasing respiratory problems and died at age 11 months. Psychomotor development was normal. His 10-year-old sister had similar craniofacial malformations and a cleft soft palate. She also had a severe deglutition dysfunction and developed a thoracolumbar kyphoscoliosis. Psychomotor development was normal. The parents were healthy and non-consanguineous. The malformations in the sibs do not fit any reported craniofacial malformation syndrome and may represent a previously unrecognized monogenic disorder. This may be an autosomal recessive or dominant trait with gonadal mosaicism in one of the parents.

[Nutritional rickets--an old disease with new relevance]. / Alimentaer rakitt. En gammel sykdom med ny aktualitet.

Rickets caused by poor nutrition was widespread in Norway at the beginning of this century. Today it is a very rare disease among Norwegian children. During the last 20 years, however, it has become quite common among immigrant children who have come from developing countries to live in Norway. This is probably due to a combination of different factors such as material vitamin D deficiency, lack of vitamin D supplementation, long-lasting breast feeding, latitude (therefore little sunshine in winter) and lack of exposure to sunshine during the summer. The paper reviews the disease, with a special emphasis on clinical findings, diagnosis, treatment and prevention.

[Nutritional rickets. An old disease with new relevance]. / Alimentaer rakitt. En gammel sykdom med ny aktualitet.

Rickets caused by poor nutrition was widespread in Norway at the beginning of this century. Today it is a very rare disease among Norwegian children. During the last 20 years, however, it has become quite common among immigrant children who have come from developing countries to live in Norway. This is probably due to a combination of different factors such as maternal vitamin D deficiency, lack of vitamin D supplementation, long-lasting breast feeding, latitude (therefore little sunshine in winter) and lack of exposure to sunshine during the summer. The paper reviews the disease, with a special emphasis on clinical findings, diagnosis, treatment and prevention.

[Balloon dilatation of postoperative esophageal stenoses in children]. / Ballongdilatasjon av postoperative oesophagusstenoser hos barn.

During the period 1987-92, seven patients (two girls and five boys under one year of age) were dilated for strictures following oesophageal atresia operation. The total number of dilatations was 47. Six out of seven patients were treated successfully. No sedation/anaesthesia was used. There was one episode of cyanosis and brief respiratory arrest, and two incidents of intramural tears. None of these episodes required surgical intervention. Fluoroscopically guided balloon dilatation of oesophageal strictures is considered a safe and efficient treatment, also for outpatients.

Prenatal diagnosis of urinary tract anomalies. The value of two ultrasound examinations.

OBJECTIVE: To determine when fetal urinary tract anomalies were detected by ultrasound screening during pregnancy and to discuss the possible consequences if only one early ultrasound examination is performed. DESIGN: A retrospective study of 47 cases where fetal urinary tract malformations were diagnosed in a two-stage screening program (17th and 32nd week of gestation) covering 22,310 women over ten years, 1982-91. SETTING: Ullevål University Hospital in Oslo which serves as a referral center for obstetric and neonatal diseases. RESULTS: Urinary tract anomalies were diagnosed in 0.18% of the pregnancies. Of these, 61.7% were found at the second routine ultrasound screening. The most difficult differential diagnoses were those of hydronephrosis without megaureter and a multicystic kidney. Hydronephrosis was found in 51% and a multicystic kidney in 21% of the cases. The tentative prenatal diagnoses were confirmed postnatally in 83% of the cases. Six of the fetuses had anomalies regarded as incompatible with postnatal life. These pregnancies were terminated, and the diagnoses verified by autopsy. Two other infants died perinatally, one of them as a result of the urinary tract anomalies. CONCLUSION: If only one ultrasound scanning had been performed in the 17th week, approximately two-thirds of the cases would not have been detected. Early intervention and follow-up after delivery would only have been performed if the infants had developed symptoms or complications related to the urinary tract anomalies.

[Invagination in children. New diagnostic and therapeutic aspects]. / Invaginasjon hos barn. Nyere diagnostiske og terapeutiske aspekter.

Based on the literature and our own experience, we recommend ultrasound examination as a routine in infants and small children with acute abdominal pain. If a pseudotumour is diagnosed, with suspicion of an intussusception, we verify the diagnosis by an air enema, and also use this for treatment under the surveillance of fluoroscopy and a conventional blood pressure manometer. The results are encouraging.

Orofaciodigital syndrome type I in a girl with unilateral tibial pseudarthrosis.

The orofaciodigital syndromes are a group of possibly seven different malformation syndromes including oral, facial, and digital malformations. Type I has X linked dominant inheritance whereas the other types show autosomal recessive inheritance. An exact diagnosis is therefore important for genetic counselling. We here report a girl with orofaciodigital syndrome type I. She had cystic kidney disease at the age of 8 months which has not previously been reported in an infant with orofaciodigital syndrome. In addition she had unilateral tibial pseudarthrosis which has only rarely been reported in the orofaciodigital syndromes and in type II only.

Ultrasonography in patients with suspected acute appendicitis: a prospective study.

The diagnostic accuracy of high-resolution real-time ultrasonography was prospectively studied in 240 patients admitted to the hospital with suspected acute appendicitis. The criteria for ultrasound diagnosis of appendicitis included a sausage-shaped, aperistaltic, hypoechoic structure when imaged along its longitudinal axis, with a target-like appearance on transverse section. The ultrasonographic findings were correlated with surgical-pathological outcome in 82 cases with proven appendicitis, with laparotomy findings in another 21 patients and with clinical follow-up in the remainder. The overall sensitivity, specificity and accuracy of ultrasonography in the diagnosis of acute appendicitis were 78%, 92% and 87%, respectively. The positive predictive value was 84% and the negative predictive value was 88%. Ultrasonography may significantly improve the diagnostic accuracy in patients with suspected acute appendicitis and should be performed in all patients in whom the clinical diagnosis is equivocal. The ultrasonographic findings must be interpreted in light of the clinical findings.

Ultrasonography and parameters of inflammation in acute appendicitis. A comparison with clinical findings.

A prospective study of 110 unselected patients with suspected acute appendicitis comprised ultrasonography and parameters of inflammation--c-reactive protein, white blood cell count, erythrocyte sedimentation rate and Yersinia antibody titer. The results were compared with the initial clinical diagnosis. Acute appendicitis was confirmed in 28 cases (prevalence 25.4%). The negative laparotomy rate was 11.4% and the appendiceal perforation rate 10.7% Clinical judgment and ultrasonography were statistically highly significant as predictors of acute appendicitis, whereas the indications given by c-reactive protein and white blood cell count did not reach statistical significance.

Cholesteatomas of the temporal bone. Preoperative C-T versus peroperative findings.

In a series of 25 ears with chronic otitis media the correlation between findings obtained by preoperative C-T of the temporal bone and observations made at surgery was evaluated. The study was performed "blindly", i.e., neither the radiologist nor the surgeon had any knowledge of the other's findings. Cholesteatoma prediction varied with location. Similar observations were made in respect to granulation tissue and erosions. A relatively high percentage of false positives and false negatives was found even in this rather small sample. To obtain better results by C-T, close co-operation and exchange of information between clinician and radiologist appears necessary, along with an explorative attico-antrotomy as a regular part of the operation.