Helicobacter pylori and Meckel's diverticula

BACKGROUND: Helicobacter pylori is known to infect only gastric mucosa and is strongly associated with gastroduodenal ulceration. The authors studied whether H. pylori colonizes the gastric mucosa of Meckel's diverticula, and determined its relationship to "gastritis" and bleeding. METHODS: A 10-year retrospective review identified 45 children with Meckel's diverticulum. Hematoxylin-eosin and Diff-Quik stains were used to assess the presence and severity of gastritis, and to highlight organisms in the resected diverticula. Cases with organisms were then studied with antibodies specific for H. pylori using immunoperoxidase methods. RESULTS: Twenty-eight children, 7 months to 12.6 years of age, had lower gastrointestinal hemorrhage caused by Meckel's diverticulum and had positive radionuclide scans. All had acid-secreting mucosa in their diverticula, and ulceration. "Chronic gastritis" and eosinophilia were constant findings; "acute gastritis" was present in four patients. Twenty specimens exhibited lymphoid follicles in the gastric mucosa. Seventeen patients with Meckel's diverticula (age range, 1 month-14.7 years) who presented with acute abdominal pain associated with intussusception were used for comparison. Acid-secreting gastric mucosa was seen in four patients. H. pylori was identified in only one of the 45 patients; this patient had ulceration and moderate "acute gastritis." CONCLUSIONS: H. pylori does not colonize a substantial number of children who have ulcerated and bleeding Meckel's diverticulum in the presence of acid-secreting mucosa. Although H. pylori is a notable cause of ulceration, the authors confirm that ulceration is possible in its absence, and alternative mechanisms of ulceration are important. The presence of lymphoid follicles in Meckel's diverticula, unlike gastric biopsies, is not associated with H. pylori.     

Meckel's diverticulum: the usefulness of 99m Tc pertechnetate scintigraphy

The paper discusses the utility and appropriateness of instrumental tests (in particular scintigraphic detection) which are regularly used for the preoperative diagnosis of Meckel's diverticulum. The case is reported of a 9-month-old infant affected by severe recidivating attacks of melena in whom the diagnosis of Meckel's diverticulum was delayed by the repeated negativity of instrumental tests.     

Sonographic diagnosis of adrenal hemorrhage in patients with fulminant meningococcal septicemia

We report two patients with fulminant meningococcal septicemia, in whom massive bilateral adrenal hemorrhages were diagnosed by ultrasound. Low plasma cortisol levels were found in one patient who eventually died. The other patient survived and has remained asymptomatic for the last three years. His adrenal function is normal. We suggest that routine ultrasound examination should be performed in patients with meningococcal sepsis and shock in order to clarify the prevalence of a renal hemorrhage. Determination of plasma cortisol levels in patients with adrenal hemorrhage, would allow identification of those with adrenal insufficiency who may benefit from steroid replacement.     

131I-Meta-iodobenzylguanidine scintigraphy in patients with neuroblastoma

Twenty-six studies by meta-(¹³¹I)-iodobenzylguanidine scintigraphy (¹³¹I-MIBG), 26 studies by⁶⁷Ga-citrate and 33^99mTc-hydorxymethylene diphosphate (^99mTc-HMDP) scintigraphic studies were performed for 10 patients with abdominal neuroblastoma. Comparing the¹³¹I-MIBG images obtained at 24, 48 and 72 h, the 48-h image was the most distinctive for the tumor. Intrabdominal primary lesions, which ranged from bean to fist-size, were visualized in 7/7 cases (100%) by¹³¹I-MIBG, 4/7 cases (57%) by⁶⁷Ga-citrate and 4/8 cases (50%) by^99mTc-HMDP before surgery and at diagnosis. In serial follow-up of these patients after starting chemotherapy,¹³¹I-MIGB detected 100% of regressing primary tumors. Studies of 5 postoperative patients showed negative images for the primary tumor in all 3 scintigraphies except one in whom¹³¹I-MIBG was positive, but not⁶⁷Ga-citrate or^99mTc-HMDP, for an unresectable residual tumor.¹³¹I-MIBG also detected metastatic lesions not predicted by⁶⁷Ga-citrate or^99mTc-HMDP and reflected tumor progression more sensitively than known tumor markers such as urinary vanillylmandelic acid (VMA), homovanillic acid (HVA), serum neuron-specific enolase (NSE) and ferritin. These findings indicate that the 48 hr¹³¹I-MIBG scintigraphy is superior to⁶⁷Ga-citrate or^99mTc-HMDP images and to other biochemical markers in monitoring the effect of treatment on neuroblastoma.     

Technetium-99m pertechnetate imaging in diagnosis of Meckel's diverticulum

Abdominal imaging after intravenous injection of ^99mTc pertechnetate is a simple, safe, and noninvasive diagnostic procedure to show ectopic gastric mucosa, which is present in most cases of symptomatic Meckel''s diverticulum. It was performed in 13 infants and children suspected of having a Meckel''s diverticulum, mainly because of unexplained rectal bleeding. Two of the three proven Meckel''s diverticula were correctly identified by scintiscanning, while meticulous contrast x-ray studies were negative in each case. It is concluded that abdominal imaging is useful in the pre-operative diagnosis of symptomatic Meckel''s diverticulum.     

“Giant Meckel's diverticulum”: Report of an unusual case in a child with preoperative X-ray diagnosis

A 9 year old boy presented with acute abdominal pain and volvulus caused by a giant cystic Meckel's diverticulum opacifiedPreoperatively by an upper tract gastrografin series.     

Angiographic diagnosis of jugular venous system dilatation in children

We report five children with a soft mass in the neck due to congenital jugular venous ectasia. Three had fusiform dilatation of the internal jugular vein, which in one case was associated with dilatation of the ipselateral external jugular vein. Two children had aneurysmal dilatation of the superficial cervical communicating vein. The first four cases required angiographic studies for final diagnosis. Venography via the femoral vein was most valuable for visualization of the dilated segments of internal jugular veins but failed to show the vascular mass communicating with the superficial vein of the neck. These were best visualized by direct injection of the contrast medium into the vessel. In the fifth case a correct diagnosis was obtained with xeroradiography alone.     

梅克尔憩室并发症101例临床分析

目的 总结梅克尔憩室并发症临床特点,提高对该病并发症的诊治水平.方法 回顾性分析我院近3年收治的101例梅克尔憩室并发症手术患儿诊疗经过,对其症状、检查、手术情况等进行统计学分析.结果 并发症中出血50例、肠梗阻37例、憩室炎7例、穿孔7例,比例约为7:5:1:1.本组梅克尔憩室99mTc检查敏感度92％,全部病例痊愈出院.结论 患儿中出血最常见,并发梗阻、炎症及穿孔术前不易确诊.99m Tc检查可以诊断梅克尔憩室,其准确率与和异位组织相关,受憩室炎症影响;与性别、年龄、病程、憩室距回盲部距离无相关性.     

Technetium bone scintigraphy in the diagnosis of osteomyelitis in children

In a 5 1/2-year retrospective study of hospitalized children with osteomyelitis who had technetium bone scans, we found that 32 of 38 (84%) had increased radionuclide uptake, 4 (11%) had normal uptake and 2 (5%) had decreased uptake. The two patients with decreased uptake had a stormy course with extensive bone destruction and pathologic fractures in spite of prolonged courses of antibiotic therapy. Decreased uptake on bone scan in patients with clinical evidence of osteomyelitis could indicate a poor prognosis and early surgical drainage is indicated in order to decrease morbidity.     

Ultrasound diagnosis of adrenal hemorrhage in meningococcemia

Two cases of adrenal hemorrhage in meningococcemia detected by ultrasound are reported. Antemortem detection of adrenal pathology may have important prognostic and therapeutic implications. The sonographic appearance may be echofree, mixed, or echogenic. Abdominal ultrasound examination can be an effective non-invasive tool in diagnosing adrenal hemorrhage.     

新生儿肾上腺出血的B超、CT诊断比较

目的 分析比较B超、CT诊断新生儿肾上腺出血的价值.方法 回顾性分析8例经证实的新生儿肾上腺出血病例,对比分析腹部B超及CT表现,男5例,女3例,发病时日龄1～14d.结果 8例均为右侧肾上腺出血,B超显示右肾上腺区三角形或类圆形病灶,边界清楚锐利可探及完整包膜;强回声2例,低回声2例,强弱混杂回声4例;4例复查体积较前均明显缩小,呈无回声区.CT平扫为单发圆形或卵圆形肿块影,均匀高密度3例;均匀低密度2例;呈环状中心高密度3例.3例复查肿块密度较前减低,体积较前缩小,1例内部小点状钙化灶.结论 应使用B超对新生儿进行肾上腺出血筛查,进一步的CT扫描可提供影像学分期.随访病例应注意残留囊性病变的观察,分析有无钙化灶的形成.