Lipoma in the thyroid?

We report a child with a nodular goiter and a lipoma in the thyroid gland. This association has not been previously described in children. Thyrolipoma and lipomatosis of the thyroid are rare tumors of similar histology and unclear etiology. The lesions and the histology described in this child might represent the beginning of this disease.     

Should the lateral chest radiograph be routine in the diagnosis of pneumonia in children? A review of the literature

OBJECTIVE:

To assess the evidence of the additive diagnostic value of the lateral chest radiograph to the frontal chest radiograph in children (zero to 18 years) with suspected pneumonia in the emergency department.

METHODS:

The MEDLINE database (1966 to 2001) was searched to identify the highest level of evidence available in support of the lateral. The key words used included chest radiograph, pneumonia and chest x-ray.

RESULTS:

Only four controlled studies were identified that assessed the role of the lateral chest x-ray. Three of these studies were retrospective. In the first study, the addition of the lateral to the frontal chest x-ray in 414 children would have detected an additional nine patients (2.3%) with pneumonia. In the second study, involving 179 patients, a high level of agreement was found between the interpretations based on the frontal chest x-ray alone and those based on both views. A third study of 359 children assessed the criterion validity of a frontal chest x-ray alone. Based upon a radiologist’s interpretation of both views as the gold standard, the sensitivity of the frontal view alone was 86%. A fourth study of 158 children with suspected pneumonia revealed that the frontal view alone was diagnostic of pneumonia in 106 of 109 (97%) patients.

CONCLUSION:

There is no randomized controlled trial evidence to support the additive value of the lateral to the frontal chest x-ray in the diagnosis of children with pneumonia. Further prospective studies are required to determine if the addition of the lateral chest x-ray will modify therapy, prevent complications or whether it is cost-efficient.     

Recurrent urinary tract infection in the post-transplant reflux nephropathy patient: Is reflux in the native ureter the culprit?

We assessed the prevalence of symptomatic, refluxing systems as a cause of recurrent urinary tract infection (UTI) in patients who underwent renal transplantation as result of renal failure from reflux nephropathy. Eleven patients from the age of 8 to 19 yr underwent renal transplantation for renal failure because of reflux nephropathy, between 1992 and 2003. Culture documented UTI were investigated and correlated with pre- and postoperative infection rates, voiding dysfunction (VD), concomitant nephrectomy, or nephroureterectomy with refluxing native remnants, and pretransplant ureteral reimplantation. Four patients with nephroureterectomies and no VD were infection free post-transplant. Two of three patients reimplanted pretransplant with a history of VD had one or more UTI per month. Patients with nephrectomies without partial ureterectomies with or without VD also had one or more UTI per month. Refluxing systems in the immunosuppressed transplant patient may play a role in UTI especially when associated with VD. Surgical intervention of native refluxing systems may be warranted.     

'Sleeping with the enemy?' Expectations and reality in imaging children in the emergency setting

As an introduction to the ALARA conference titled "Building Bridges between Radiology and Emergency Medicine: Consensus Conference on Imaging Safety and Quality for Children in the Emergency Setting," it is important for us to understand the landscapes of both the pediatric radiology and emergency medicine subspecialties. Recognizing potentially different practice patterns, including perspectives on pediatric care, as well as shared and sometimes unique professional pressures, can help us identify common concerns and problems and facilitate the development of strategies aimed at correcting these issues.     

Genomic imprinting and the expression of affect in Angelman syndrome: what's in the smile?

BACKGROUND: Kinship theory (or the genomic conflict hypothesis) proposes that the phenotypic effects of genomic imprinting arise from conflict between paternally and maternally inherited alleles. A prediction arising for social behaviour from this theory is that imbalance in this conflict resulting from a deletion of a maternally imprinted gene, as in Angelman syndrome (AS), will result in a behavioural phenotype that should evidence behaviours that increase access to maternally provided social resources (adult contact). METHOD: Observation of the social behaviour of children with AS (n = 13), caused by a deletion at 15q11-q13, and a matched comparison group (n = 10) was undertaken for four hours in a socially competitive setting and the effect of adult attention on child behaviours and the effect of child smiling on adult behaviours evaluated using group comparisons and observational lag sequential analyses. RESULTS: The AS group smiled more than the comparison group in all settings, which had different levels of adult attention, and more when the level of adult attention was high. Smiling by children with AS evoked higher levels of adult attention, eye contact and smiling both than by chance and in comparison to other children and this effect was sustained for 30 s to 50 s. Smiling by children with AS was frequently preceded by child initiated contact toward the adult. DISCUSSION: The results are consistent with a kinship theory explanation of the function of heightened levels of sociability and smiling in Angelman syndrome and provide support for an emotion signalling interpretation of the mechanism by which smiling accesses social resources. Further research on other behaviours characteristic of Angelman and Prader-Willi syndromes warrant examination from this perspective.     

Upregulated expression of EGF and TGF-α in the proximal respiratory epithelium in the human hypoplastic lung in congenital diaphragmatic hernia

Newborn infants with congenital diaphragmatic hernia (CDH) still have a high mortality rate. Epidermal growth factor (EGF) and transforming growth factor- (TGF-) are peptide growth factors involved in the fetal lung growth and development. The EGF and TGF- have been reported to promote pulmonary branching activity and alveolar type-II pneumocyte proliferation. Epidermal growth factor and TGF- immunoreactivity and mRNA expression in the bronchial and bronchiolar epithelium is maximal during early fetal life and barely detectable in the proximal airways of neonatal lung. The purpose of this study was to determine protein and gene expression of EGF and TGF- in CDH lung in order to elucidate the potential role of these growth factors in the pathogenesis of pulmonary hypoplasia in CDH. Lung tissue specimens were obtained from archival lung tissue from 11 patients with CDH and 5 controls. Indirect immunohistochemistry was performed using ABC method with anti-EGF and anti-TGF- antibodies. In situ hybridization was performed using EGF and TGF- specific digoxigenin-labeled oligonucleotide probes. The most striking difference between hypoplastic CDH lung and control lung was the strong EGF and TGF- mRNA expression and immunoreactivity in the bronchial and bronchiolar epithelium in CDH lung. The upregulated protein and gene expression of EGF and TGF- in the proximal airways in the CDH hypoplastic lung suggests persistence of fetal stage of pulmonary airway development in CDH.