Posterior knee pain: primary symptom of a small non-occlusive venous clot

A healthy 9 year old girl presented with severe posterior knee pain and a small segmental non-occlusive popliteal venous thrombosis. The case is relevant for its unique presentation and symptoms. Lack of recanalisation persisted at one year follow up.     

Intrauterine pericardial effusion. Early symptom of a primary symptomatic congenital cytomegaly]

We report of a fetus who was ultrasonographically shown to have growth retardation, oligohydramnios and a pericardial effusion without other components of a hydrops fetalis at 28 weeks' gestation. At 29 weeks' gestation the child was born by cesarean section of pathological CTG. A congenital cytomegaly was diagnosed. The etiological role of the infection for the development of the pericardial effusion is discussed.     

Severe abdominal pain as a presenting symptom of probable catastrophic antiphospholipid syndrome

Catastrophic antiphospholipid syndrome (APS) in pediatric medicine is rare. We report 3 adolescents who presented with acute onset of severe abdominal pain as the first manifestation of probable catastrophic APS. The 3 patients, 2 male patients and 1 female patient were 14 to 18 years old. One had been diagnosed with systemic lupus erythematosus in the past, but the other 2 had no previous relevant medical history. All presented with excruciating abdominal pain without additional symptoms. Physical examination was noncontributory. Laboratory results were remarkable for high inflammatory markers. Abdominal ultrasonography was normal, and abdominal computed tomography scan showed nonspecific findings of liver infiltration. Only computed tomography angiography revealed evidence of extensive multiorgan thrombosis. All patients had elevated titers of antiphospholipid antibodies. The patients were treated with full heparinization, high-dose steroids, and intravenous immunoglobulin with a resolution of symptoms. One patient was resistant to the treatment and was treated with rituximab. In conclusion, severe acute abdominal pain can be the first manifestation of a thromboembolic event owing to catastrophic APS even in previously healthy adolescents. Diagnosis requires a high index of suspicion with prompt evaluation and treatment to prevent severe morbidity and mortality.     

Back pain as a first symptom of hematologic malignancy in a 9-year-old girl

Described case involves 9-year-old, otherwise healthy girl, which was admitted to a local hospital due to acute back pain persisting for a couple of days. Pain appeared suddenly, without any preceding trauma, and was accompanied by fever. Physical examination was normal apart from forced, defensive back flexion. Initial laboratory tests showed elevated inflammatory markers without any additional changes in blood cell count. Patient was transferred to Rheumatology Department of Children's Clinical Hospital in Lublin, Poland for further diagnosis and treatment. Extensive diagnostic procedures were performed, including bone scan, MRI of the spinal column and multiple laboratory tests. Pain and fever persisted despite intensive anti-inflammatory and antibiotic therapy. Changes in blood morphology led to extended oncological diagnostics. Eventually patient was diagnosed as having acute lymphoblastic leukemia (pre-B ALL).     

Epidemiology of musculoskeletal pain in primary care.

AIMS: (1) To determine the proportion of children evaluated for musculoskeletal pain in a paediatric primary care clinic over a three year period; (2) to describe the number of office visits due to musculoskeletal pain; (3) to categorise the more common presenting complaints; and (4) to characterise the aetiology of musculoskeletal pain in a paediatric primary care clinic. METHODS: Retrospective chart review of all children > or =3 and <15 years of age evaluated in an urban paediatric primary care clinic in Madrid between 1 January 1997 and 31 December 1999. RESULTS: (1) A total of 317 children were evaluated for musculoskeletal pain throughout the study. The prevalence of musculoskeletal pain increased as children grew older, from 2.4-5.7% at age 3 to 27.5-36% at age 14. Regression analysis showed that age (OR 1.20) and gender (OR 0.75) were associated with MSP. (2) Musculoskeletal pain was reported in 397 of 6500 office visits (6.1%; 95% CI 5.5 to 6.7%). (3) Arthralgias and soft tissue pain represented 65% of the presenting musculoskeletal complaints. (4) Trauma was the most common aetiology, responsible for 44% of all musculoskeletal pain related office visits. Mechanical/overuse pathology (23.9%) and osteochondroses (10.3%) represented the second and third leading aetiologies. CONCLUSIONS: Musculoskeletal pain is a common presenting complaint in primary care. The number of children presenting with musculoskeletal pain increases as they grow older, being particularly frequent among the adolescent population. The spectrum of aetiologies involved is limited, to the extent that three are responsible for almost 80% of cases.     

An unusual case of knee pain

Osteomyelitis of the patella is a rare disease, which primarily affects the pediatric population. We present a case of hematogenous osteomyelitis of the patella with secondary development of septic arthritis of the knee. There is often a delay in diagnosis, as illustrated by our case report, due to the rarity of the condition and nonspecific presentation. There is usually no history of trauma. Focal tenderness over the patella is the most helpful clinical sign. A small joint effusion may be present which is usually sterile and reactionary due to inflammation of the patella. Treatment of osteomyelitis of the patella is similar to treatment of osteomyelitis in other areas. Function and range of motion of the knee usually returns to normal after completion of treatment. A delay in diagnosis may lead to progression of disease and complications such as septic arthritis of the knee.     

Review for the generalist: evaluation of anterior knee pain

Anterior knee pain is common in children and adolescents. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of chronic anterior knee pain in the pediatric population with a focus on patellofemoral pain.     

以Evans综合征为首发症状的系统性红斑狼疮一例

患儿男,11岁。因反复发热、酱油样尿、皮肤出血点10天,抽搐3天人院。患儿10天前发热38℃左右,自服退热片等第2天热退,出现酱油样尿,皮肤出血点,于当地医院诊断为自身免疫性溶血性贫血伴血小板减少综合征,予对症治疗1周。病程中有2次反复溶血,3d前出现间断的头痛呕吐,强直性抽搐,逐渐出现烦躁不安、昏迷、体温升高,因病情加重转入我院。     

Recurrent abdominal pain in primary care: study of functional recurrent abdominal pain

Pediatricians find that in daily clinical practice they are frequently visited by parents with children that have recurrent abdominal pain. Clinical experience has demonstrated that, after performing all relevant diagnostic tests, no medical condition justifying such investigations is involved in more than half of these disorders. Consequently, these disorders are called functional recurrent abdominal pain. The dramatic nature of their children's symptoms often leads parents to seek urgent medical consultations and ask for additional complementary tests; in serious cases, these disorders can lead to prolonged hospitalization with no proven therapeutic efficacy and which pose an additional risk for the child's mental health. In most patients, psychological factors are involved which play a key role in the onset and persistent nature of abdominal pains. Consequently, a psychopediatric approach preserving therapeutic continuity should be adopted. For these reasons, we consider a review of the psychiatric and psychological aspects involved in this disorder to be opportune.     

以再发性腹痛为首发症状的全身性疾病

儿童时期以再发性腹痛 (ＲＡＰ)为首发症状的疾病中 ,器质性疾病约占 5% ,功能异常者占 85% ,心理问题占 1 0 % [1 ] 。所涉及的疾病范围甚广。全身性器质性疾病如消化系统 :有溃疡病 ,胃肠道感染 ,肠系膜淋巴结炎 ;泌尿生殖系统 :有泌尿道感染 ,肾结石 ,盆腔炎 ,子宫内膜异位症等 ;肝胆系统 :有肝炎 ,家族性胰腺炎 ,胆囊炎等 ;代谢性疾病有血卟啉症 ,家族性高脂血症等 ;其它 :如铅中毒 ,荨麻疹 (腹型 ) ,遗传性血管神经性水肿 ,过敏性紫癜 (腹型 ) ,系统性红斑狼疮等。功能异常者有乳糖、蔗糖不耐受 ,便秘 ,肠道气体综合征 ,肠道运动功能增…     

Posterior urethral valves: incidence and progress of vesicoureteric reflux after primary fulguration

This is a prospective study of 20 cases of posterior urethral valves (PUV) presenting between the ages of 12 days and 5.5 years (median 15 months) in order to determine the incidence and progress of vesicoureteric reflux (VUR), hydronephrosis (HN), and renal functional status. The efficacy of fulguration as the sole modality of treatment for PUV was assessed in terms of improvement or disappearance of VUR over a 6-month follow-up period. VUR was present in 60% of the patients, being unilateral in 41.7%. Out of 19 renal units with VUR, reflux subsided in 31.5% by 3 months and 78.94% by 6 months. The blood urea and serum creatinine levels, which were raised in 50% of the patients at presentation, came down to normal by 6 months in all the cases. Improvement in glomerular filtration rates (GFR) was noted in all the children at each follow-up and was found to be statistically significant (p<0.01). HN was present in all the patients at presentation and was bilateral in 90%. It decreased significantly during the follow-up period, though its complete disappearance was seen only in one case. Vesicoureteric reflux dysplasia syndrome (VURD) was present in two cases. Our study showed that VUR disappeared in a majority of the cases by 6 months once adequate urethral patency was restored, although hydronephrosis persisted.     

以骨关节疼痛为首发症状的7例急性白血病误诊分析

幼年型特发性关节炎尤其是少关节炎型主要以骨关节疼痛为主要表现,有的局限于某个大关节,有的可表现为多关节疼痛、肿胀,甚至存在关节腔积液,临床上常常以此作为诊断该病的主要标准而开始治疗。我们将近几年在外院诊断为幼年型特发性关节炎,并进行相关治疗,由于疗效不佳转来本院,在本院经反复检查最后确诊为急性白血病的7例病例总结分析如下。