RESUMEN
OBJECTIVES: To propose an easy and reproducible sonographic screening test able to avoid late presentation of developmental dysplasia of the hip (DDH). METHODS: The pubo-femoral distance (PFD) cut-off point was determined on 980 infants who underwent ultrasonography of the hips in comparison with the final diagnosis, based on clinical, ultrasound data and follow-up. PFD reproducibility was tested on 52 hips by both an experienced and an inexperienced radiologist. After teaching this screening method to general radiologists, its impact was evaluated by analysing the rate of late diagnosis in an entire administrative area. RESULTS: An abnormal PFD threshold above 6 mm gave a sensitivity of 97.4 % for the diagnosis of DDH (271 hips) and a specificity of 84 %. Sensitivity increased to 100 % when taking into consideration children of 1 month or older. The PFD measurement stayed reproducible even in inexperienced hands (k = 0.795). For 3 years, following the extension of screening to all female infants, there was no late diagnosis of DDH in girls in amongst a catchment area of 1 million inhabitants. CONCLUSIONS: PFD measurement with a threshold for abnormality of 6 mm at the age of 1 month, without asymmetry above 1.5 mm, could eradicate DDH late diagnosis.
Asunto(s)
Algoritmos , Puntos Anatómicos de Referencia/diagnóstico por imagen , Diagnóstico Tardío/prevención & control , Fémur/diagnóstico por imagen , Luxación Congénita de la Cadera/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador/métodos , Hueso Púbico/diagnóstico por imagen , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Tamizaje Masivo/métodos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
A medium carbon martensitic steel containing nanometer scale secondary hardening carbides and intermetallic particles is investigated by field ion microscopy and atom probe tomography. The interaction between the concomitant precipitations of both types of particles is investigated. It is shown that the presence of the intermetallic phase affects the nucleation mechanism and the spatial distribution of the secondary hardening carbides, which shifts from heterogeneous on dislocations to heterogeneous on the intermetallic particles.
RESUMEN
At one month, the acetabular depth from a standard lateral coronal section is 4.6 ± 1.0mm. The correlation between experienced and junior radiologists is high (kappa 0.795). A treshhold of 6mm with a Δ (difference between right and left) less than 1.5mm provides a sensitivity of 100% for the detection of DDH at one month. Universal US screening at one month of all high-risk infants in 2009 resulted in a reduction of delayed diagnosis of DDH (zero girls, two boys) in Ille-et-Vilaine due to continuous medical education of general radiologists.
Asunto(s)
Luxación Congénita de la Cadera/diagnóstico por imagen , Árboles de Decisión , Femenino , Humanos , Recién Nacido , Masculino , Tamizaje Neonatal/métodos , UltrasonografíaRESUMEN
PURPOSE: Antibiotic prophylaxis is given to children at risk for urinary tract infection. However, evidence concerning its effectiveness in grade I to III vesicoureteral reflux is lacking. The objective of this study was to determine whether antibiotic prophylaxis reduces the incidence of urinary tract infection in young children with low grade vesicoureteral reflux. MATERIALS AND METHODS: Children 1 month to 3 years old with grade I to III vesicoureteral reflux were assigned randomly to receive daily cotrimoxazole or no treatment, and followed for 18 months. A urinary tract infection constituted an exit criterion. Infection-free survival rates were calculated using the Kaplan-Meier method and compared using the log rank test. RESULTS: A total of 225 children were enrolled in the study. Distribution of gender, age at inclusion and reflux grade were similar between the 2 groups. There was no significant difference in the occurrence of urinary tract infection between the 2 groups (17% vs 26%, p = 0.2). However, a significant association was found between treatment and patient gender (p = 0.017). Prophylaxis significantly reduced urinary tract infection in boys (p = 0.013), most notably in boys with grade III vesicoureteral reflux (p = 0.042). CONCLUSIONS: These data suggest that antibiotic prophylaxis does not reduce the overall incidence of urinary tract infection in children with low grade vesicoureteral reflux. However, such a strategy may prevent further urinary tract infection in boys with grade III reflux.