Exophytic urinary bladder lesions in childhood

A retrospective study of the clinical presentation, diagnosis, and treatment of eight patients whose common characteristic was an exophytic, solid urinary bladder lesion (botryoid rhabdomyosarcoma, transitional-cell carcinoma, nephrogenic adenoma, cystitis cystica, von Brunn's nests, hemangioma, and squamous-cell metaplasia) is presented. Exophytic bladder lesions, some of which are of great importance, are rare entities in childhood and present nonspecific clinical pictures. Therefore, whenever a space-occupying lesion is detected on a complementary study of the lower urinary tract, the differential diagnosis should be considered. Advantages of each of the currently available diagnostic methods are discussed and the essential role of cystoscopy is stressed.     

Reversible brain lesions in childhood hypertension

Posterior leukoencephalopathy syndrome is characterized by an acute, usually reversible, encephalopathy with transient occipital lobe abnormalities detected on MRI that occur mostly in association with acute hypertension. The clinical presentation includes seizures, headache, altered mental status and blindness. Disturbed autoregulation of cerebral blood flow and endothelial injury are central to the pathogenesis of this disorder. Prompt control of hypertension results in rapid and complete neurological recovery. In this report we discuss the cases of two children with acute onset hypertension of different aetiologies that presented with the characteristic features of posterior leukoencephalopathy syndrome. CONCLUSION: Early recognition of this readily treatable condition may obviate the need for extensive and invasive investigations. Despite the alarming lesions on the MRI, prompt control of hypertension carries a uniformly favourable prognosis.     

Malignant lesions of the ovary in childhood

Approximately half of all lesions of the ovary in childhood are neoplastic, yet only a small fraction of neoplastic lesions contain malignant elements. Overall, malignancies of the ovary account for 10% of all ovarian masses and 1% of childhood cancers. Primary ovarian malignancies fall into three broad categories based on the cell type of origin. Germ cell tumors predominate and may be further subdivided based on the differentiation of the malignant cells. Epithelial cell tumors, which are most common in adults, and sex-cord stromal tumors each make up 15% of the total in children. Rare malignant lesions and metastatic disease account for the small remaining group of tumors. Regardless of tumor type, the majority of patients present with localized disease, but proper surgical staging is important to determine the need for adjuvant therapy. The development of platinum-based chemotherapeutic regimens has resulted in significant improvements in long-term survival, even for children who present with advanced stage disease.     

Laser options for vascular lesions in childhood

To determine which laser can be used for a vascular lesion, the different working mechanisms of the individual lasers must first be understood. The localization and diameter of the vessels to be treated define whether a certain laser is appropriate for that lesion. For teleangiectasias and port-wine stains the pulsed-dye laser works without scarring. Hemangiomas respond only when flat and superficial. Deeper lesions can only be reached with the ND-Yag laser.     

Perineal lesions in childhood Crohn disease]

BACKGROUND: Perineal lesions (PAL) usually evolve together with bowel disease and often constitute a serious and disabling complication of Crohn's disease. PATIENTS: Forty-three children (47%) with Crohn's disease developed PAL in a retrospective study of 92 patients ranging in age from 4 to 20 years. RESULTS: PAL occurred at the mean age of 11.4 +/- 0.7 years, prior to diagnosis in 25% or subsequently in 21%. PAL were severe: complex fistulae (15%), rectovaginal fistulae (2%), anal raggedness (13%); moderate: subcutaneous fistulae (11%), abscesses (19%), cavitating ulcers (9.5%) and stricture formations (5.7%); or mild: eczema (6.7%), fissures (57%) and skin tags (17%). An association with these various features has been observed in 31%. The extent of involvement of the gastrointestinal tract was rectosigmoid (72%), ileal and colonic (41%), ileal with pancolitis (12%). Two PAL course profiles were observed: one with exacerbation and remissions (52%), the other without remission (48%), especially anal raggedness (100%), cavitating ulcers (80%) and skin tags (61%). Medical treatment included steroids (54%), metronidazole (53%), salicylates (51%), nutritional support (44%), azathioprine (17%). PAL healed in 41%. Surgical treatment was performed in 27% with 83% of healing. Relapses occurred in 35% after medical treatment and 86% after surgery.     

Important melanocytic lesions in childhood and adolescence

Melanocytic nevi are common in children and adolescents, and the preponderance of these lesions are benign. Congenital melanocytic nevi, dysplastic nevi, and large numbers of common acquired nevi, however, may indicate an increased risk of malignant melanoma. With the exception, possibly, of giant congenital nevi, melanoma associated with these lesions generally occurs in adulthood. Nonetheless, some patients can be identified as being at increased risk for the development of melanoma during childhood. The poor prognosis associated with advanced melanoma and the curability of early lesions underscore the importance of prompt recognition of melanoma when it does occur in children. Furthermore, physicians who care for children are in a key position to decrease risk of melanoma throughout the lifespan by encouraging avoidance of excessive sun exposure during childhood.     

Preoperative diagnosis of abdominal space-occupying lesions in childhood

Between 1977 to 1986 results of ultrasonography in 56 patients has been compared with computed tomography (CT), excretory urography, and in 19 cases with arteriography. In comparison to ultrasonography CT proved superior in diagnosing dignity (87% vs. 78%); in appointing to the original organ, and in diagnosing the type of tumour angiography turned out to be clearly superior to CT (89% vs. 65%, and 79% vs. 43%, resp.) Addition of CT to ultrasonography resulted in a gain of 10% concerning dignity, of 30% concerning appointing to the origin, and of 24% with respect to typing. With the question of renal or extrarenal origin of a mass lesion the EUG proved to be indispencable. The following procedure is recommended: in kidney-related tumours US plus EUG, in other cases additional imaging techniques only for special problems, or specific questions preoperatively. The routine implementation of computed tomography in abdominal masses seems not to be necessary.     

Post-operative cardiac lesions after cardiac surgery in childhood

A new population of patients in cardiology has been growing steadily so that the number of grown-ups with congenital heart disease (GUCH) is almost equal to those under paediatric care. The dramatic improvement in survival should lead to a larger number of GUCH patients than children with CHD in the new millennium. Although echocardiography remains the imaging modality of choice, cross-sectional imaging techniques have a decision-aiding function for the postoperative evaluation of surgical reconstructions as well as in the preparation of complex interventional procedures. Cardiovascular CT and MRI are often complementary in providing comprehensive complex anatomical evaluation, haemodynamic assessment of residual postoperative lesions and complications of surgery. A thorough understanding of postsurgical corrections is a prerequisite for choosing the optimal imaging techniques and achieving an accurate evaluation.     

Sonographic diagnosis of solid space-occupying abdominal lesions in childhood

Between 1981 and May 1986 31 children with solid abdominal tumor masses were observed in our clinic. The first diagnostic procedure was a sonographic examination, followed by further radiological investigations if necessary. 30 cases were examined histologically; in one case the sonographic findings were confirmed by an angiography. The most frequent abdominal masses were neuroblastomas and Wilms tumors (7 cases each). A mesoblastic nephroma was diagnosed in 3 cases, a lymphoma, a hepatoblastoma and a rhabdomyosarcoma 2 times each. One time we found a pancreas carcinoma, a teratoma, a hemangiomatosis of the liver, a malignant Schwannoma, a Ewing sarcoma, an adenoma of the adrenal gland, a pheochromocytoma and an osteosarcoma. According to our own experience and recent reports in the literature it seems possible in most cases, to predict the correct diagnosis of solid abdominal masses using the informations of sonographic imaging. Sonography is a highly specific non-invasive diagnostic tool for planning treatment (e.g. early surgery, cytostatic therapy and/or radiation) of solid abdominal masses. Nevertheless the histological examination should be performed in every case to confirm the definitive diagnosis.     

小儿肺炎支原体肺炎与心肌损害的临床分析

目的：探讨肺炎支原体肺炎是否引起和加重心肌损害。方法：对临床诊断为肺炎支原体肺炎且MP-IgM阳性(简称MP组)及临床诊断为细菌性肺炎且MP-IgM阴性(简称非MP组)各100例,通过心电图、临床观察、血清心肌酶学检查等进行对比研究。结果：肺炎支原体肺炎组出现窦性心动过速、ST-T段改变及早搏的发生率明显高于非MP肺炎组。临床观察肺炎支原体肺炎连续3 d心动过速及心衰的发生率也明显高于细菌性肺炎组(P<0.05)。血清酶学CK-MB,LDH,LDH1在两组间也存在明显差异(P<0.05)。提示肺炎支原体肺炎的心肌损害更严重,应及早提出防治措施。     

Caustic gastroesophageal lesions in childhood: an analysis of 473 cases

Ingested corrosive agents produce oropharyngeal and gastroesophageal injuries ranging from minor burns to severe necrosis, depending on the agent amount, concentration, and duration of exposure. The aim of this study was to present our patients with corrosive ingestion retrospectively. Four hundred seventy-three children younger than 16 years of age (mean age, 3.7+/-0.1 years) who were admitted to our hospital for suspected corrosive ingestion between the years 1995 and 2003 were studied. Two hundred eighty-six (60.5%) of 473 patients were males. Household bleaches (36.6%) and oven cleaners (23%) were the most frequently encountered corrosive agents. During endoscopy, lesions in the esophagus were recorded in 379 children. Eighty-one of the cases had gastric lesions. During the follow-up, esophageal stricture, esophageal perforation, and gastric outlet obstruction (GOO) developed in 11 cases, 1 case, and 2 cases, respectively. Caustic ingestion of alkali substances such as oven cleaner seem to cause more severe injuries. Early admission to the hospital with clinical and endoscopic evaluation and early surgery when required may reduce morbidity and mortality.     

Residual small airways lesions after kerosene pneumonitis in early childhood

To assess residual lung damage after a single insult early in life, we studied 14 asymptomatic children, 10 years after an episode of kerosene pneumonitis. Immediately after kerosene ingestion all patients developed pulmonary symptoms. Eight had abnormal chest radiographs (group 1) whereas in six there were no radiographical changes (group 2). The average age at follow-up was 11.4 (range: 9.4–13.2). Lung volumes, expiratory flow-rates and their density dependence were measured and compared to an age, sex, and a height-matched control group. The volume of isoflow (Viso ) was significantly higher in patients in group 1 (27.75%±6.7) when compared to group 2 (5.48%±3.56) or controls (5.63%±2.31) (P<0.02). The mean max 50 was 13.5%±3 for group 1, and 27.9%±4.11 for group 2 (P<0.005). Airway reactivity assessed by an exercise test was normal in all children. Four of the eight patients from group 1 still had abnormal chest radiographs 10 years after kerosene pneumonitis. Thus, subclinical, prolonged small airway abnormalities after kerosene pneumonitis seem to be related to the severity of the acute insult.     

Rocky mountain spotted fever: hepatic lesions in childhood cases

We studied 16 fatal childhood cases of Rocky Mountain spotted fever (RMSF). Hepatic histologic lesions with statistically significant differences from age- and sex-matched controls were portal triaditis consisting of polymorphonuclear leukocytes and large mononuclear cells, portal vasculitis, sinusoidal leukocytosis, erythrophagocytosis by Kupffer cells, and gross hepatic weight. Hepatocellular necrosis, cholestasis, and congestion were not more frequent in RMSF than in controls. Using immunofluorescence microscopy, we were able to demonstrate rickettsial organisms in portal blood vessels and sinusoidal lining cells of 7 cases.     

儿童基底神经节病变的病因与鉴别诊断

基底节主要包括尾状核、壳核和苍白球,共同构成锥体外系的核心,接受来自几乎所有大脑皮层区的投射信息,并进行整合。随着医学影像学技术的发展,CT和MRI能够准确地诊断深部灰质核团的病变,特别是基底节区域损害。任何脑内代谢异常过程都可能导致基底节生化和结构异常。急性致病因素如:缺氧、低血糖、一氧化碳中毒、溶血性尿毒综合征、渗透性髓鞘溶解和脑炎;慢性因素更为复杂如:遗传性疾病中的遗传代谢病、Huntington病,获得性疾病中如炎症、急性损伤后遗症等(见表1)。以往认为运动障碍多因基底节病变所致,然而并不是所有基底节病变都会引…     

Destructive skeletal lesions as the primary initial manifestation of acute childhood leukemia

Bony involvement in leukemia has been long recognized in the medical literature. However, severe osseous changes, as the sole initial manifestation of childhood leukemia is a unique feature of the case reported here.