Unilateral Pulmonary Edema: Unusual Presentation of Acute Rheumatic Fever

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical condition and not readily recognized early and managed accordingly. Acute rheumatic fever, which is a common disease in developing countries, does not commonly present with UPE. We report a 13-year-old girl presenting with UPE following acute rheumatic fever mimicking pneumonia. We conclude that UPE should be considered in the differential diagnosis for the patient with clinical criteria of rheumatic fever who presents with unilateral lung opacification. With early recognition and antifailure treatment, it is possible to reduce morbidity and mortality in such patients.     

Congenital Hydrocolpos Combined with Unilateral Renal Agenesis

Herein we report an infantile case of congenital hydrocolpos combined with left renal agenesis which presented with an abnormal mass protruding from the vaginal introitus. The diagnosis was made shortly after birth by ultrasonography and confirmed by other radiologic diagnostic methods. This case highlights the value of ultrasonography in diagnosing hydrocolpos and determining the coexistence of renal anomalies.     

Unilateral hearing impairment in children

An overview and update are offered on difficulties experienced by children with monaural sensorineural deafness. It is the general consensus that children with unilateral hearing loss experience few, if any, communication and/or educational problems. The medical and educational status of a group (N = 60) of children with unilateral, hearing impairment are described. In addition, the auditory, linguistic, and behavioral manifestations of unilateral hearing impairment were studied in considerable detail for a subsample of these 60 children. The results revealed that approximately one third of the children with unilateral hearing loss had failed at least one grade. Nearly 50% of the group had either failed a grade and/or needed resource assistance in the schools. The small subsample of children with unilateral hearing loss performed much poorer than a matched group of children with normal hearing on both a localization and a syllable recognition task. Finally, the data on behavioral and linguistic manifestations of monaural hearing loss indicate that children with unilateral hearing impairment are experiencing more problems than previously supposed.     

Unilateral pulmonary edema and acute rheumatic fever

Although the diagnostic criteria for acute rheumatic fever (ARF) are well known, a high index of suspicion is necessary in order to assure timely diagnosis and appropriate treatment. We present a case of an 8-year-old child who presented with unilateral pulmonary edema secondary to acute mitral insufficiency due to ARF. ARF should be considered in the differential diagnosis of unilateral pulmonary edema in children.     

Unilateral hypoxic-ischemic injury in young children from abusive head trauma, lacking craniocervical vascular dissection or cord injury

Background Abusive head trauma (AHT) in young children usually has a severe outcome when associated with hypoxic-ischemic encephalopathy (HIE), which is best characterized by MRI in the acute or subacute phase utilizing diffusion-weighted imaging (DWI). HIE in this setting has been hypothesized to result from stretching of the spinal cord, brainstem, or vasculature. Objective To provide clinical correlation in patients with unilateral HIE and to postulate a mechanism in the setting of suspected AHT. Materials and methods IRB approval was obtained. Over a 5-year period, the medical records and images were reviewed of the 53 children ≤3 years of age who presented with acute head trauma according to the hospital registry. The children were subselected in order to determine how many suffered either HIE or AHT, and to detect those with unilateral HIE. Results In 11 of the 53 children, the etiology of the head trauma was highly suspicious for abuse. In 38 the head trauma was accidental and in 4 the trauma was of unknown etiology and at the time of this report was unresolved legally. Of the 53, 4 suffered HIE confirmed by CT or MRI. In three of these four with HIE the trauma was considered highly suspicious for AHT. Two of these three were the only patients with unilateral HIE, and both (7 months and 14 months of age) presented with early subacute phase HIE seen on DW MRI (range 4–7 days) and are described in detail with clinical correlation. The third child with AHT and HIE had bilateral findings. In the fourth patient the HIE was bilateral and was considered accidental. The work-up for both patients with unilateral HIE included head CT, craniocervical MRI, and craniocervical MR angiography (MRA). In both, there was mostly unilateral, deep white matter restricted diffusion, with subdural hematomas that were small compared to the extent of hypoxic-ischemic insult, and no skull fracture. Craniocervical MRA and axial thin-section fat-saturation images were negative for dissection, brainstem, or cord injury. Legal authorities obtained a confession of inflicted injury in one and a partial confession in the second (which did not fit the extent of injury). Five other children with HIE (based on DWI) were found during this period who had not suffered head trauma; all were bilateral insults. Conclusion HIE associated with AHT might present with largely unilateral white matter injury on DWI following extensive cortical infarction. We propose that unilateral HIE in a young child might be a sign of AHT and might result from cervical vascular compression, whether from kinking during hyperflexion/hyperextension or from direct strangulation.     

Unilateral pulmonary agenesis and renal anomalies associated with<Emphasis Type="Italic">in situ</Emphasis> neuroblastoma of the adrenal gland

An association of unilateral pulmonary agenesis within situ neuroblastoma of adrenal gland in a newborn having multiple congenital anomalies is being reported. Polycystic right kidney and absent left kidney, leading to severe oligohydramnios with secondary Potter’s syndrome and Breech deformation sequence, were additional malformations present in our proposita     

儿童脊柱肿瘤

目的 探讨儿童脊柱肿瘤的临床特点、诊断、治疗方法及预后。方法回顾性分析我院1991年1月-2003年10月治疗的16岁以下脊柱肿瘤及瘤样病变44例，男27例，女17例；平均9．6岁。良性肿瘤（包括瘤样病变）38例，恶性肿瘤3例，转移瘤3例。疼痛39例，肿块9例，侧弯或斜颈8例，不同程度神经损害14例。18例初诊不确定或与最后诊断不符。发病至确诊时间平均8．5个月。手术治疗17例，化疗10例，放疗8例，手术与化疗1例，手术与放疗2例，放弃治疗3例，观察3例。结果围手术并发症4例。35例获平均5．5年随访。良性肿瘤及瘤样病变患儿手术或放疗或化疗后疗效较满意，所有患儿的局部疼痛消失，除1例外，所有患儿神经功能均有改善，3例病变复发再次手术。4例出现后弯畸形。6例恶性肿瘤和转移瘤患儿全部死亡。2例嗜酸性肉芽肿患儿症状消失，病变得到控制。结论对于儿童脊柱肿瘤，根据肿瘤的性质选择恰当的治疗方法，良性肿瘤与肿瘤样病变预后良好，恶性肿瘤及转移瘤治疗效果欠佳。     

Radiation enteritis in children

Six children with intestinal radiation injury following cancer therapy are presented. The radiation dose varied from 3500 rads to 6600 rads. Symptoms of radiation enteritis took from 3 weeks to 3 years to develop. All patients received concomitant chemotherapy. Incomplete bowel obstruction was the most common presenting feature (four cases); five came to laparotomy. Simple adhesiolysis was successful in two cases; two children required more extensive surgical manoeuvres (small-bowel bypass and bowel resections). All are alive and well 4 to 13 years following therapy although five have other radiation effects. Radiation injury to the bowel and its management are discussed. Offprint requests to: H. Rode     

Bronchoscopic Diagnosis of Asymptomatic Unilateral Pulmonary Vein Atresia in an Infant

An eight-month-old boy with findings of persistent left pulmonary basal infiltrate was diagnosed with congenital unilateral pulmonary vein atresia by bronchoscopy. Cardiac catheterization documented slow left pulmonary venous return to atretic pulmonary veins. Conservative treatment was chosen because the child was asymptomatic and corrective surgery or percutaneous intervention was not technically possible. After a 3-year follow-up, the child still has no documented pulmonary hypertension. Early diagnosis of unilateral pulmonary vein atresia is important to anticipate potential threatening complications like pulmonary hypertension and hemoptysis. Surgical treatment of this entity might be drastic and complex and should be weighed against a conservative alternative and careful follow-up.     

Infectious endocarditis in children

Summary With the object of analyzing current characteristics of infectious endocarditis (IE) in children, we carried out a retrospective study of 23 cases of IE in children under 15 years of age seen at the Hospital Ramón y Cajal in Madrid (Spain) between 1977 and 1985.The incidence was high (1.3 cases per 1000 children admitted). The male/female ratio was 21. Eight patients were under 2 years of age and 15 over 2 years, the majority being adolescents. The two groups presented marked etiological and prognostic differences. Congenital heart disease was the predisposing factor in 20 of the 23 cases.Streptococcus viridans (nine cases) andStaphylococcus aureus (eight cases) were the most frequent organisms. Fourteen cases were on a native valve and nine were secondary (seven of these on prosthetic patches).In spite of advances in therapy, IE continues to be a severe illness: the mortality rate in our series was 26%. Factors associated with a poor prognosis were: age less than 2 years,Staphylococcus aureus as the causative agent, and the presence of prosthetic material.     

Liver transplantation in children

Liver transplantation has become the curative surgical therapy of end-stage acute, chronic and metabolic liver disease. This has been made possible by improvements in surgical techniques, such as segmental liver transplantation and by improvements in liver preservation. In parallel, advances in immunosuppression and anti-infective therapy have been achieved. As a result of this progress there is an increasing demand for liver transplantation which raises questions for ethical and socioeconomic consideration.     

Unilateral right-sided internal jugular phlebectasia in asthmatic children

The most common cause of a neck mass that increases in size on straining is laryngocele. Internal jugular phlebectasia, which is of unknown cause, may present similarly. We present three cases of internal jugular phlebectasia, all of whom were asthmatic children. This association of asthma and internal jugular phlebectasia has not been reported previously.     

Unilateral nasal obstruction in children: Pai syndrome

Unilateral obstruction of the nasal cavity in children is mainly caused by the introduction of foreign bodies further stated with rhinorrhea and fetid odor. Less commonly, it can be traumatic, neoplastic, due to congenital malformation or iatrogenic. Symptoms of congenital intranasal mass may present at birth, or go unnoticed and be a finding in a routine pediatric examination. Patient evaluation should include imaging studies to guide the diagnosis and rule out intracranial extension. A syndrome associated with congenital nasal tumor should be suspected when other abnormalities are present. Pai syndrome is a rare genetic disorder. Its manifestations are craniofacial being congenital nasal polyp his main marker. We present a patient with unilateral nasal respiratory failure secondary to congenital nasal lipoma, with craniofacial anomalies belonging to Pai syndrome. Nasal obstruction was successfully surgically resolved.     

Imidazoline intoxication in children

A 15-month-old girl with rhinopharyngitis was treated with a nasal solution containing the imidazoline derivative naphazoline. She rapidly developed profound CNS depression with stupor, hypothermia, hypoventilation and bradycardia. All symptoms disappeared within 24 h. The symptomatology of 18 other paediatric cases of naphtylimidazoline exposure reported to the Belgian National Poison Centre, is also discussed. Imidazoline intoxication due to overdose or accidental ingestion but also after normal therapeutic usage is frequent in children. It can cause severe CNS depression, especially in very young children. For these reasons vasoconstrictor imidazoline containing solutions should be prescribed with caution and kept out of reach of children.     

Acute pancreatitis in children

Aim: To identify clinical, laboratory, and imaging characteristics associated with severe acute pancreatitis in children. Methods: This was a retrospective study of children under 18 years of age with acute pancreatitis between September 1993 and August 2008. Severity of pancreatitis was graded according to established criteria. Clinical, laboratory and radiological data for mild and severe pancreatitis were collected for analysis. Results: There were 180 cases of pancreatitis; 51 (28.3%) met criteria for severe disease. Severe pancreatitis was most commonly associated with systemic disease (22 of 51; 43.1%) and trauma (13 of 51; 25.4%). Patients with severe pancreatitis had significantly higher body weight, higher frequency of dyspnoea and pleural effusion, and lower serum calcium and albumin levels. Ten patients with systemic disease died; four of them had systemic lupus erythematosus (SLE). Computed tomography (CT) was more accurate than ultrasound in evaluation of the severity of pancreatitis. Conclusions: Acute pancreatitis in children is associated with significant morbidity and mortality. The severity of paediatric pancreatitis may be influenced by aetiology. CT is recommended for evaluation of severity of pancreatitis.     

儿童闭塞性细支气管炎的研究进展

闭塞性细支气管炎是指小气道损伤后炎症及纤维化引起的慢性气流阻塞的临床综合征,儿童表现为重症呼吸道感染后持续咳嗽、喘息及活动不耐受.重症下呼吸道感染、心肺移植、骨髓移植、Stevens-Johnson综合征、结缔组织病、吸入或摄入有毒物质及药物因素等均可导致闭塞性细支气管炎的发生.闭塞性细支气管炎诊断主要依据临床表现、高分辨率CT和肺功能检查,肺组织活检是诊断闭塞性细支气管炎的金标准.目前尚没有公认的闭塞性细支气管炎治疗准则.早期阶段是临床治疗的关键时期.多数采取持续使用糖皮质激素和支气管舒张剂,同时联合其他支持治疗.该文从病因、发病机制、病理、临床表现、辅助检查、诊断、鉴别诊断及治疗方面对儿童闭塞性细支气管炎进行综述.     

不明原因中毒的诊断步骤与初期救治

本文探讨了不明原因中毒的临床症状与体征,强调病史、体检、实验室检查为不明原因中毒患儿确诊最重要的三个步骤,提出对该病进行初期救治的原则.     

Round pneumonia in children

We evaluated four children with rounded densities on their chest radiographs in whom the final diagnosis was presumed to be lower respiratory tract infection. The differential diagnose between round pneumonia and a neoplastic process is difficult to make. In this report, all of cases of round pneumonia have resolved clinically and radiographically with antibiotic therapy.