CT urograms in pediatric patients with ureteral calculi: do adult criteria work?

Background: Secondary signs of urinary obstruction associated with ureteral calculi are useful adjuncts to diagnosis in adults with renal colic evaluated by unenhanced helical CT. Objective: Our purpose was to evaluate the frequency of secondary signs of obstruction in children with renal colic undergoing unenhanced helical CT. Materials and methods: Ureteral calculi were identified in 20 of 61 children with acute flank pain examined by unenhanced helical CT. Each imaging study was evaluated for the presence of secondary signs of urinary obstruction. The frequencies of individual signs were compared with each other by means of the McNemar test. Results: Six children had no secondary sign identified. In the remaining 14 children, proximal ureteral dilatation was seen in 10, renal enlargement in 10, hydronephrosis in 9, tissue rim sign in 6, decreased kidney attenuation in 5, and perinephric stranding in 1. Comparison of the frequencies strongly suggested that perinephric stranding occurs less frequently than proximal ureteral dilatation (P = 0.004), hydronephrosis (P = 0.008), or renal enlargement (P = 0.012). Conclusion: Perinephric stranding, a common secondary sign in adults with ureteral calculi, occurs less frequently in children than other reported secondary signs. Received: 31 October 2000 Accepted: 15 May 2001     

Pediatric Hodgkin lymphoma: are we over-scanning our patients?

Despite the favorable outcome of most pediatric patients with Hodgkin lymphoma (HL), there is rising concern about risks of carcinogenesis from both diagnostic and therapeutic radiation exposure for patients treated on study protocols. Although previous studies have investigated radiation exposure during treatment, radiation from post-treatment surveillance imaging may also increase the likelihood of secondary malignancies. All diagnostic imaging examinations involving ionizing radiation exposure performed for surveillance following completion of therapy were recorded for 99 consecutive pediatric patients diagnosed with HL from 2000 to 2010. Cumulative radiation dosage from these examinations and the frequency of relapse detection by these examinations were recorded. In the first 2 years following completion of therapy, patients in remission received a median of 11 examinations (range 0-26). Only 13 of 99 patients relapsed, 11 within 5 months of treatment completion. No relapse was detected by 1- or 2-view chest radiographs (n = 38 and 296, respectively), abdomen/pelvis computed tomography (CT) scans (n = 211), or positron emission tomography (PET) scans alone (n = 11). However, 10/391 (2.6%) of chest CT scans, 4/364 (1.1%) of neck CT scans, and 3/47 (6.4%) of PET/CT scans detected relapsed disease. Thus, only 17 scans (1.3%) detected relapse in a total of 1358 scans. Mean radiation dosages were 31.97 mSv for Stage 1, 37.76 mSv for Stage 2, 48.08 mSv for Stage 3, and 51.35 mSv for Stage 4 HL. Approximately 1% of surveillance imaging examinations identified relapsed disease. Given the very low rate of relapse detection by surveillance imaging stipulated by current protocols for pediatric HL patients, the financial burden of the tests themselves, the high cure rate, and risks of second malignancy from ionizing radiation exposure, modification of the surveillance strategy is recommended.     

Transition from pediatric to adult diabetes care: smooth or slippery?

de Beaufort C, Jarosz‐Chobot P, Frank M, Frank M, de Bart J, Deja G. Transition from pediatric to adult diabetes care: smooth or slippery? Objectives: The purpose of this study is to evaluate the practices of diabetes health care providers concerning the transition from pediatric to adult diabetes care. The information presented here may help increase awareness of the organization of transitional care for young people with diabetes and prevent the loss of follow‐up during this vulnerable period in their lives. Methods: A questionnaire with an explanatory letter was sent to all members (n = 578) of the International Society for Pediatric and Adolescent Diabetes (ISPAD). A follow‐up mailing was sent 4 months later. Results: In total, 92 questionnaires (16%) from members representing 36 countries were included in the analysis. In 76% of the centers, youth are seen until the age of 18 yr; 36% of the pediatric centers see adults > 25 yr; 30% report children under the age of 16 receive follow up from adult diabetologists or internists. About half of the programs already have a structured transition process usually targeting youth 16–25 yr of age. The majority of responders propose that preparation for transition starts at least 1 yr prior to leaving the pediatric center. Conclusion: Youth with type 1 diabetes often struggle to keep diabetes management a priority and find it challenging to maintain optimal metabolic control. When they graduate from pediatric care, some of these young people opt out of care altogether, only to resurface in the medical system when they develop complications which may have been prevented. Our survey of diabetes health care professionals in 36 countries worldwide shows that the actual transition practices in many places are far from optimal and require improvement. Transitional care should start early and strategies should promote uninterrupted, comprehensive, and accessible adult care.     

Riding a bicycle: Do we need more than a helmet?

Background: To assess pediatric bicycle‐related traumatization in view of types of injuries, incidence and modes of prevention. Methods: Retrospective study of pediatric cases admitted to the pediatric intensive care unit of a university‐affiliated level II trauma hospital in Israel over 12 consecutive years. Results: Forty‐six patients (three girls, 43 boys) with bicycle‐related injuries formed 1% of the total pediatric intensive care unit admissions during the study period. The number of patients with bicycle‐related injuries increased significantly during recent years (1996–2001 vs 2002–07: P= 0.003). Most of the cases presented abdominal injuries (54.4%) followed by head (32.6%) and chest (13%) injuries. The median age of patients with abdominal trauma was significantly lower in comparison to patients with other types of injuries (P= 0.002). Abdominal cases required longer hospitalization compared with other patients (P= 0.003). Falling from a bicycle was the main mechanism of injury in abdominal cases (88%) (P= 0.003). Motor vehicle impacts were the main mechanism of injury in patients with head (60%) and chest (66.6%) trauma. Conclusion: The incidence of severe bicycle‐related injuries requiring intensive care hospitalization is increasing and abdominal trauma forms the main portion of those injuries. We suggest introducing a trunk‐protective measure for young bicyclists. Exact information on the mechanism of the injury is important for evaluating the injured patient more accurately.     

Primary mediastinal B‐cell lymphoma in the pediatric patient: Can a rational approach to therapy be based on adult studies?

The literature on adult and pediatric primary mediastinal B‐cell lymphoma (PMBCL) was reviewed and compared. Biologically, adult PMBCL has more similarities to Hodgkin Lymphoma (HL) than diffuse large B‐cell lymphoma (DLBCL). Pediatric studies suggest that the biology is similar to that in adults. Median age of children is 14.3 years and the overall survival (OS) is reported as 78.6% and event‐free survival (EFS) as 67.4%. Adverse prognostic factors included LDH >500 and mass size over 10 cm, with a trend towards better survival in younger patients. Studies in adults show better survival with intensified chemotherapy and the addition of rituximab. Data on the use of radiation therapy show improved CR rates and survival with addition of involved field radiation therapy (IFRT). Positron emission tomography (PET) with computerized tomography (CT) imaging response‐assessment after two courses and at therapy‐end may allow for the rational use of IFRT in pediatric/adolescent patients who are more susceptible to development of adverse late effects. Pediatr Blood Cancer 2009;52:566–570. © 2008 Wiley‐Liss, Inc.