MR imaging of transient synovitis: differentiation from septic arthritis

Background Transient synovitis is the most common cause of acute hip pain in children. However, MR imaging findings in transient synovitis and the role of MR imaging in differentiating transient synovitis from septic arthritis have not been fully reported. Objective To describe the MR findings of transient synovitis and to determine whether the MR characteristics can differentiate this disease entity from septic arthritis. Materials and methods Clinical findings and MR images of 49 patients with transient synovitis (male/female 36/13, mean age 6.1 years) and 18 patients with septic arthritis (male/female 10/8, mean age 4.9 years) were retrospectively reviewed. Results MR findings of transient synovitis were symptomatic joint effusion, synovial enhancement, contralateral joint effusion, synovial thickening, and signal intensity (SI) alterations and enhancement in surrounding soft tissue. Among these, SI alterations and enhancement in bone marrow and soft tissue, contralateral joint effusion, and synovial thickening were statistically significant MR findings in differentiating transient synovitis from septic arthritis. Conclusions The statistically significant MR findings in transient synovitis are contralateral (asymptomatic) joint effusions and the absence of SI abnormalities of the bone marrow. It is less common to have SI alterations and contrast enhancement of the soft tissues. The statistically significant MR findings in septic arthritis are SI alterations of the bone marrow, and SI alterations and contrast enhancement of the soft tissue. Ipsilateral effusion and synovial thickening and enhancement are present in both diseases.     

Legg-Calve-Perthes disease following transient synovitis. How often?

Forty-one children with transient synovitis of the hip and 10 children with Legg-Calve-Perthes disease were followed. All 41 cases of transient synovitis had a benign outcome. In this series, nine of the 10 children with Legg-Calve-Perthes disease were diagnosed upon their first roentgenographic examination. One child whose first diagnosis was transient synovitis remained symptomatic for 4 months, when he developed roentgenologic changes consistent with Perthes disease. The literature is reviewed and 455 cases of transient synovitis analyzed. Only one patient with transient synovitis developed Legg-Calve-Perthes disease after having been asymptomatic for a period of 3 months. In 17 other cases, symptoms persisted until Legg-Calve-Perthes was diagnosed. It is suggested that transient synovitis is a benign disease and that only children with protracted symptoms are at risk to develop Perthes disease.     

Lyme arthritis presenting as transient synovitis of the hip

Transient synovitis of the hip is a common cause of hip pain in children. The etiology of transient synovitis of the hip is unknown. Lyme arthritis is characterized by brief, often recurrent episodes of oligoarthritis. Lyme arthritis most often affects a single knee, but hip involvement is uncommon. This report describes 2 children with Lyme arthritis who presented with features of transient synovitis of the hip. Lyme arthritis should be considered in the differential diagnosis of transient synovitis of the hip in children.     

Interferon production in children with respiratory syncytial, influenza, and parainfluenza virus infections.

To better understand the recovery process of infants with lower respiratory tract disease due to respiratory syncytial virus, the production of interferon by 129 children (ages 10 days to 24 months) with RSV infection was compared to that of 20 children with influenza (ages 1 to 36 months), and 37 children with parainfluenza virus infection (ages 4 to 66 months). Interferon assays of 285 nasal washes from children with RSV revealed that interferon production occurred in only 5 (4%) of the children. Significantly more children infected with infleunza virus, 55% (P less than 0.001), and parainfluenza virus, 30% (P less than 0.001), produced interferon. In addition, the quantity of interferon produced by children with RSV (geometric mean titer = 2) was significantly less than that of children with influenza (GMT = 26.8, P less than 0.001) and parainfluenza virus (GMT = 23.5, P less than 0.001). In the children infected with RSV, in constrast to those with influenza, interferon detection was not associated with diminished shedding of virus.     

Specificity and indications of bone scan in non-neoplastic bone and joint disease in children. A study of seventy cases

We studied 70 bone scans in pediatric patients to define the indications of this procedure in non-neoplastic disease. Sensitivity of bone scans in infections proved outstanding except in children under one year of age. Eighty-nine per cent of children with pain and fever and a positive bone scan had either an infection or osteochondritis. The same symptoms with a negative bone scan indicated either transient synovitis of the hip or the absence of bone lesions in 83% of cases. Children with pain as the only symptoms and a negative bone scan consistently had either transient synovitis of the hip, or normal bones and joints (100% of cases). Eighty-two per cent of children with pain and a positive bone scan had an infection or osteochondritis. Indications of bone scanning vary according to clinical features and include all children with functional impairment, pain and fever, and isolated limps with no obvious cause.     

Selenium in Plasma and Erythrocytes in Patients with Down's Syndrome and Healthy Controls

ABSTRACT. The mean plasma selenium concentration (P-Se) in 65 patients with Down's syndrome (DS) did not differ from that in 90 healthy controls. The concentration of selenium in the erythrocytes (E-Se) was higher in DS patients than in controls ( p <0.001). P-Se and E-Se increased progressively with age through childhood in both DS children and controls. The former children, however, started out with higher levels of E-Se and reached adult concentrations earlier (at 7-17 years) than controls (18 years). Adult DS patients and controls did not differ in their mean P-Se or E-Se concentration. There was a significant correlation between P-Se and E-Se both in DS patients and in controls. In DS patients each of these two variables was significantly correlated to glutathione peroxidase (GSH-Px) activity in erythrocytes. A sex difference in the DS children, but not in the controls, was observed with regard to P-Se and E-Se levels, these being higher in DS girls during childhood (0-17 years). This was in accordance with an earlier finding of higher GSH-Px activity in DS girls than in DS boys.     

Selenium in plasma and erythrocytes in patients with Down's syndrome and healthy controls. Variation in relation to age, sex and glutathione peroxidase activity in erythrocytes

The mean plasma selenium concentration (P-Se) in 65 patients with Down's syndrome (DS) did not differ from that in 90 healthy controls. The concentration of selenium in the erythrocytes (E-Se) was higher in DS patients than in controls (p less than 0.001). P-Se and E-Se increased progressively with age through childhood in both DS children and controls. The former children, however, started out with higher levels of E-Se and reached adult concentrations earlier (at 7-17 years) than controls (greater than or equal to 18 years). Adult DS patients and controls did not differ in their mean P-Se or E-Se concentration. There was a significant correlation between P-Se and E-Se both in DS patients and in controls. In DS patients each of these two variables was significantly correlated to glutathione peroxidase (GSH-Px) activity in erythrocytes. A sex difference in the DS children, but not in the controls, was observed with regard to P-Se and E-Se levels, these being higher in DS girls during childhood (0-17 years). This was in accordance with an earlier finding of higher GSH-Px activity in DS girls than in DS boys.     

Age and family history at presentation of pediatric inflammatory bowel disease

OBJECTIVES: Young children are thought to be a unique subset of pediatric patients with inflammatory bowel disease (IBD). The authors' objective was to evaluate the differences in initial clinical presentation of young and older children with IBD and to determine whether a positive family history of IBD is associated with the age of presentation. METHODS: The authors reviewed the records of all patients with new diagnoses of Crohn disease (CD) and ulcerative colitis (UC) who presented between July 1996 and July 1999. Initial evaluation included assessment of growth parameters and laboratory values (hemoglobin concentration, platelet count, erythrocyte sedimentation rate, and serum albumin). Inquiry regarding a family history of IBD was made in every patient. RESULTS: There were 153 patients with new diagnoses (82 with CD and 71 with UC), with a mean age of 11.9 years (range, 16 months-18 years). The children with CD had a higher sedimentation rate and platelet count and a lower mean hemoglobin concentration and serum albumin at presentation than did children with UC. Body mass index (BMI) was significantly lower in patients with newly diagnosed CD than in those with UC. The only significant laboratory differences between patients younger than 11 years and those 11 years or older was a higher mean platelet count in patients with CD who were younger than 11 years. Of the younger patients with CD, 41.7% had a positive family history of IBD, which was significantly greater that that found in the older patients with CD. CONCLUSIONS: Except for higher platelet counts, a lower BMI, and a higher frequency of positive family history in young children with CD, there were no significant differences in the presentation of young children with IBD compared with older children.     

Recurrences of transient synovitis of the hip

Thirty six children with transient synovitis of the hip had a total of 80 recurrences, 69 of them personally observed, and 11 described by the mother. No features distinguished the initial attack of those who had a recurrence from that of the 18 children who have not so far had a recurrence. We analysed the total of 126 episodes. In 72 there was evidence of an associated infection from the history, clinical signs, and a raised antistreptolysin O titre or isolation of a pathogen from a throat swab. The prognosis is difficult to assess because the symptoms, signs, and special investigations are not specific. Recurrences can occur after many years without symptoms.     

Factors influencing the academic performance of school children with epilepsy

The academic performance and intelligence quotient (IQ) of 50 children with epilepsy aged between 5 and 14 years, attending normal primary schools in Enugu, were compared with those of their non-epileptic classmates. The academic performance was assessed using the overall scores achieved in terminal examinations in the 2001-2002 academic year. IQ was assessed using the Draw-A-person Test. The influences of school absence rate, Rutter behavioural scores, socio-economic status and seizure-related variables on academic performance were then determined. Twenty-six percent of the children with epilepsy had a low overall score, and therefore poor academic performance, compared with 16% of the controls (p = 0.35). The mean IQ of the children with epilepsy was significantly lower than that of the controls (p = 0.02). The mean school absence rate for the children with epilepsy was significantly higher than that of the controls (p = 0.001). The mean Rutter score of the children with epilepsy was significantly higher than that for the controls (p < 0.001). On multiple linear regression analysis, only IQ (p = 0.01) and seizure type (p = 0.03) had significant predictive effects as risk factors for low overall scores and poor academic performance. It is concluded that the academic performance of epileptic children is influenced by their IQ and type of seizures rather than by other seizure variables or socio-demographic characteristics.     

Recurrences of transient synovitis of the hip.

Thirty six children with transient synovitis of the hip had a total of 80 recurrences, 69 of them personally observed, and 11 described by the mother. No features distinguished the initial attack of those who had a recurrence from that of the 18 children who have not so far had a recurrence. We analysed the total of 126 episodes. In 72 there was evidence of an associated infection from the history, clinical signs, and a raised antistreptolysin O titre or isolation of a pathogen from a throat swab. The prognosis is difficult to assess because the symptoms, signs, and special investigations are not specific. Recurrences can occur after many years without symptoms.     

The painful hip: evaluation of criteria for clinical decision-making

Children with a painful hip present a diagnostic challenge since clinical differentiation between septic arthritis, transient synovitis and Perthes disease may be difficult. Septic arthritis, a potentially life-threatening and debilitating medical emergency, requires early recognition for successful treatment, while transient synovitis and Perthes disease may be managed conservatively. An “ideal” single test for discrimination between these conditions is currently not available. We assessed the value of clinical examination and simple laboratory tests together with radiography and hip ultrasound in differentiating septic arthritis from transient synovitis and Perthes disease by analyzing the records of 89 children treated at our institution for hip pain. Ultrasound, radiographs, laboratory, clinical, and follow-up data were available for all the children. Diagnoses were made according to established criteria. Transient synovitis was present in 64 patients, septic arthritis in 8 (of whom 2 had additional osteomyelitis), and Perthes disease in 4. All children with septic arthritis had hip effusion shown by ultrasound and at least two of the following criteria: fever, elevation of erythrocyte sedimentation rate (ESR) and of C-reactive protein (CRP). None of the children without effusion on ultrasound or who lacked two or all criteria had septic arthritis. Radiographs had no significant impact on the decision-making in primary evaluation of acute hip pain. Conclusion We conclude that investigation of painful hips in children, based on hip ultrasound, body temperature, ESR and CRP, may allow cases for hip joint aspiration to be selected efficiently and may reduce the number of radiographs and hospital admissions. Received: 11 May 1999 / Accepted: 2 June 1999     

初发过敏性紫癜患儿肾脏受累危险因素分析

目的 对初发过敏性紫癜(HSP)患儿进行随访,探讨HSP患儿肾脏受累的危险因素.方法 前瞻性纳入2009年12月至2010年11月在南京医科大学附属南京儿童医院肾脏科住院的初发HSP患儿,随访6个月,根据肾脏受累定义,将HSP患儿分为肾脏受累组和无肾脏受累组.复习文献提取与肾脏受累可能相关的3项人口学特征、8项临床症状...     

The painful hip joint in the child: differential diagnosis and therapy of coxitis fugax, Perthes disease and septic coxitis]

The differential diagnosis of a painful hip joint in children is important. Transient synovitis is frequently seen in children from 3 to 7 years of age with a short history of limping. The joint effusion is visualized by ultrasound. Radiograms and laboratory data are negative. Therapy consists of short term bed rest supported by an oral antiphlogistic drug. Children with Legg-Calve-Perthes disease complain about knee or hip pain in an early stage. X-ray documentation in the a.p and axial view are mandatory as well as ultrasound visualization of the accompanying effusion. Healing of the capital femural epiphysis is aided by weight relief and improved head containment. This may need from one to three years according to the age of the child and the amount of head involvement. More than half of the children's hips with Perthes disease surgical help to achieve a satisfactory result. Hip pain is overwhelming in cases of septic arthritis of the hip joint. This is the most important help to differentiate septic coxitis from transient synovitis or Perthes disease. Rapidly rising values of red cell sedimentation and c-reactive protein are important for early diagnosis. Septic effusions are visualized by ultrasound. X-ray changes are absent in the beginning and are seen only in delayed cases. Early arthrotomy with scrupulous rinsing of the joint, followed by parenteral antibiotic treatment, is the treatment of choice.     

儿童髋关节暂时性滑膜炎临床流行病学分析

目的探讨深圳地区儿童髋关节暂时性滑膜炎的临床流行病学特征。方法采用回顾性调查方法,制作调查表对本院收治705例儿童髋关节暂时性滑膜炎患儿病因、临床表现、治疗及预后等进行临床流行病学调查,并分析结果。结果以四季散发为特征;好发于3-7岁男童,男女比例约为2.91;发病前1周有上呼吸道感染病史、剧烈活动或外伤史患儿分别占19.3%和11.9%;以痛性跛行、髋关节活动障碍为其临床特点;经卧床牵引1-2周治愈;约6.95%患儿复发。结论儿童髋关节暂时性滑膜炎好发于男童,呈四季散发,与上呼吸道感染、剧烈活动或外伤密切相关,此病可复发,经卧床牵引治疗后预后均良好。     

Prospective evaluation of clinical and laboratory effects of intrathecal chemotherapy on children with acute leukemia

The objective of this prospective 18-month study was to evaluate the clinical and laboratory effects of repeated intrathecal injections of chemotherapy in children with acute leukemia. All procedures were performed under general anesthesia, and complications were prospectively recorded. Laboratory measurements included lumbar puncture opening pressure, cerebrospinal fluid (CSF) chemistry, and cell count and morphology. Central venous pressure and ophthalmologic examinations were also performed. Forty-seven children underwent 247 intrathecal injections of chemotherapy. Adverse effects (13.7% of the procedures) included nausea and vomiting, back pain, and headache. One child each had transient cauda equina syndrome, transient communicating hydrocephalus, and persistent sacral plexus injury. The mean lumbar puncture opening pressure was significantly higher after intrathecal therapy than before (22 +/- 8 vs. 15 +/- 9 cm H2O, P = 0.02) and higher than reported in age-matched children without leukemia. All CSF chemistries, cell count, and morphology were normal. The overall incidence of complications was 13.7%. Most were mild and resolved quickly, but significant neurologic complications did occur. Lumbar puncture opening pressure was significantly higher in children with acute leukemia after intrathecal chemotherapy.     

Association of Haemophilus influenzae infection with environmental and climatic factors in Suzhou,China北大核心CSCD

Objective To investigate the epidemiological characteristics of respiratory Haemophilus influenzae (HI) infection in children in Suzhou, China and its association with climatic factors and air pollutants. Methods The data on air pollutants and climatic factors in Suzhou from January 2016 to December 2019 were collected. Respiratory secretions were collected from 7 940 children with acute respiratory infection who were hospitalized during this period, and bacterial culture results were analyzed for the detection of HI. A stepwise regression analysis was used to investigate the association of HI detection rate with air pollutants (PM2.5, PM10, NO2, SO2, CO, and O3) and climatic factors (monthly mean temperature, monthly mean humidity, monthly total rainfall, monthly total sunshine duration, and monthly mean wind speed). Results In 2016-2019, the 4-year overall detection rate of HI was 9.26% (735/7 940) among the children in Suzhou. The children aged <1 year and 1-<3 years had a significantly higher HI detection rate than those aged ≥3 years (P <0.01). The detection rate of HI in spring was significantly higher than that in the other three seasons, and the detection rate of HI in autumn was significantly lower than that in the other three seasons (P<0.001). The multiple linear regression analysis showed that PM10 and monthly mean wind speed were independent risk factors for the detection rate of HI: the detection rate of HI was increased by 0.86% for every 10 µg/m3 increase in the concentration of PM10 and was increased by 5.64% for every 1 m/s increase in monthly mean wind speed. Air pollutants and climatic factors had a lag effect on the detection rate of HI. Conclusions HI is an important pathogen for acute respiratory infection in children in Suzhou and is prevalent in spring. PM10 and monthly mean wind speed are independent risk factors for the detection rate of HI. © 2022 Xiangya Hospital of CSU. All rights reserved.     

Cervical lymph node infections with non-tuberculous mycobacteria in preschool children: interferon gamma deficiency as a possible cause of clinical infection

Epidemiological studies have demonstrated a prevalence of positive PPD reactions to non‐tuberculous mycobacteria (NTM) in 9% of 4–5‐y‐old children in the Göteborg area. Very few children of this age develop suppurative infections in lymph nodes that require surgical procedures. The hypothesis was that these children might have T cell deficiencies with abnormalities of macrophage functions, particularly with type 1 cytokines. Twenty‐four children who needed operations were investigated immunologically and compared to 10 children of the same age operated on for non‐infectious reasons. The methods used were flow cytometry analysis of lymphocytes in blood, blood lymphocyte stimulation assays and interferon gamma analyses. The patients had significantly lower levels of interferon gamma than the controls after stimulation with Candida antigens or Con A. The numbers of T and B lymphocytes were higher in patients than in controls. Conclusion: Children with necrotic lymph node infections in the cervical region due to NTM had lower interferon gamma production after stimulation than healthy age‐matched controls.     

Faecal calprotectin levels in infants with infantile colic, healthy infants, children with inflammatory bowel disease, children with recurrent abdominal pain and healthy children

This study investigated faecal calprotectin concentration, a measure of intestinal inflammation, in infants and children with abdominal pain. Faecal calprotectin was measured by an enzyme-linked immunosorbent assay kit in spot stool samples in 76 infants with typical infantile colic, 7 infants with transient lactose intolerance and 27 healthy infants. All infants were 2-10 wk of age. In addition, 19 children with recurrent abdominal pain (RAP; mean age 11.5 y), 17 with inflammatory bowel disease (IBD; mean age 11.1 y; 10 had Crohn's disease and 7 ulcerative colitis) and 24 healthy children (mean age 5.3 y) were studied. In infants with infantile colic the mean faecal calprotectin concentration was not different from that in healthy infants (278 +/- 105 vs 277 +/- 109 mg kg(-1), p = 0.97) or in infants with transient lactose intolerance (300.3 +/- 124 mg kg(-1), p = 0.60). The calprotectin level was similar in boys and girls and fell significantly with age (p = 0.04). Children with IBD had faecal calprotectin levels (293 +/- 218 mg kg(-1)) much higher than healthy children (40 +/- 28 mg kg(-1), p < 0.0001) and children with RAP without identified organic disease (18 +/- 24 mg kg(-1), p < 0.0001). Conclusion: Faecal calprotectin may differentiate between functional abdominal pain and IBD in school-aged children. In young infants high faecal calprotectin levels are normal.     

Long-term outcome of chronic hepatitis B in adolescents or young adults in follow-up from childhood

BACKGROUND: It has not yet been defined whether children with chronic hepatitis B are likely to develop severe liver disease in the future. The purpose of this study was to evaluate the evolution of chronic hepatitis B acquired in childhood. METHOD: Fifty-two children in the age range of 0 to 15 years who were positive for hepatitis B surface antigen and hepatitis B e antigen in serum for at least 6 months were enrolled in this study. In the majority of the 52 children, hepatitis B virus infection was acquired by perinatal transmission. All 52 showed abnormal liver function test findings for more than 6 months before enrollment, and the subjects were followed up longitudinally for 3 to 22 years (mean, 11 years). They are now more than 15 years of age (15-27 years old). RESULTS: During the follow-up period, 26 (50%) children had spontaneous seroconversion to anti-hepatitis B e. Serum levels of alanine aminotransferase normalized in these 26 children. In one child of these children, hepatocellular carcinoma developed at the age of 21 years, 16 years after seroconversion, although his liver function profiles remained normal. The other 26 children remained hepatitis B e antigen positive, most with unchanged biochemical features. Sixteen (62%) children among these 26 children were treated with interferon-alpha. Eleven (69%) children had seroconversion to anti-hepatitis B e within the first year after the cessation of therapy. Hepatocellular carcinoma developed in 1 of these 11 children at the age of 16 years, 6 years after interferon therapy. Thus, hepatocellular carcinoma developed in two children in an anti-hepatitis B e positive phase. CONCLUSION: All children carrying hepatitis B surface antigen should be observed carefully to monitor the possible development of hepatocellular carcinoma, especially in the antihepatitis B e-positive phase after spontaneous seroconversion or even after interferon treatment.