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Biomedical subjects

V Rathaus

Publications and source records attributed to V Rathaus.

At least 19 recordsLinked to original sources
PubMed2005

Enlarged mesenteric lymph nodes in asymptomatic children: the value of the finding in various imaging modalities.

The purpose of this study was to determine the prevalence of enlarged mesenteric lymph nodes in asymptomatic children. We prospectively studied 189 consecutive asymptomatic children from the outpatients' nephrological clinics who were referred for abdominal ultrasound. For comparison, we retrospectively reviewed the abdominal CT studies of 99 children, performed following blunt abdominal trauma. The children of both groups were divided into four subgroups according to their ages. The size, the number and the morphology of mesenteric lymph nodes were assessed. On abdominal ultrasound, enlarged mesenteric lymph nodes were detected in 55 of 189 asymptomatic children (29.1%). The longitudinal diameter of the lymph nodes ranged between 5 mm and 19 mm. These lymph nodes were arranged in clusters (three to nine in number in a cluster). All the lymph nodes were oval-shaped, flattened, and without any discomfort following graded transducer compression. On abdominal CT, enlarged mesenteric lymph nodes were diagnosed in 28 of the 99 children (28.3%). These lymph nodes measured more than 5 mm and were arranged in clusters (three or more in number). In seven of these children associated minimal mural thickening of the terminal ileum was seen. The presence of enlarged mesenteric lymph nodes in asymptomatic children of all ages and in both sexes is a common, non-specific finding and should be evaluated only in the appropriated clinical context.

Adolescent↗
PubMed2003

CT findings in patients with familial Mediterranean fever during an acute abdominal attack.

The aim of this study is to present the abdominal CT findings of patients with familial Mediterranean fever (FMF) examined during an acute abdominal attack. CT scans of 17 patients (10 women and 7 men; age range 11-45 years) were retrospectively reviewed. Attention was directed to mesenteric or peritoneal abnormalities and to the presence of appendiceal pathology. Patients were divided into two groups; group A (n=14) consisted of patients with an acute abdominal attack caused by FMF, and group B (n=3) consisted of patients whose attack proved to be owing to a separate pathology requiring surgery. Characteristic CT findings of acute abdomen in FMF included mesenteric pathology (n=12), mainly of engorged vessels with thickened mesenteric folds, mesenteric lymphadenopathy (n=6) and ascites (n=6). Signs of focal peritonitis were found in four patients. Radiologists should be familiar with such CT findings of peritoneal irritation in patients with FMF during an acute attack, and may suggest this clinical diagnosis in the proper clinical setting in a patient who has not been previously diagnosed. Alternatively, the radiologist should be aware of the possibility of a concurrent acute appendicitis or other acute abdominal pathology in patients with known FMF and should search for it.

Abdomen, Acute↗
PubMed2002

Urogenital abnormalities in male children with cystic fibrosis.

BACKGROUND: Congenital bilateral absence of the vas deferens (CBAVD) is presumed to occur prenatally and is present in over 99% of adult males with cystic fibrosis (CF). AIMS: To describe ultrasonic features in male children with CF. We aimed to describe urogenital anomalies, comparing pancreatic sufficient and insufficient CF patients. METHODS: Pelvic and scrotal ultrasonography were performed in 12 boys with CF aged 2-12 years and 16 age matched healthy controls. RESULTS: Nine patients had pancreatic insufficiency (PI): seven had two severe mutations and two had unknown mutations. Three boys were pancreatic sufficient (PS), two with splicing mutations (5T and 3849+10kb C-T respectively) and borderline sweat tests. Seminal vesicles were visualised in 5/12 patients and 8/16 controls, compared to non-visualisation reported in all adults with CBAVD. Testicular microlithiasis was found in 4/18 PI, 0/6 PS, and 0/32 control testes, compared to 0.6-1.4% in healthy males and 15% in CF adults; 7/18 PI, 4/6 PS, and 0/32 control testes were smaller than predicted for age. The epididymal head was non-homogeneous with cysts, hypo-, or hyper-echogenicity in 5/18 PI, 1/6 PS, and 0/32 control testes. CONCLUSIONS: Genital abnormalities may occur early in CF, but are less common than described in adults. They are found more often in pancreatic insufficient than in pancreatic sufficient CF patients. However, a positive finding, if present, may aid in the diagnosis of the latter. A larger longitudinal study is recommended to better define the onset and progression of urogenital abnormalities.

Child↗
PubMed2001

Malposition of catheters during voiding cystourethrography.

The aim of this study was to report catheter malposition during voiding cystourethrography. Eight hundred forty-three voiding cystourethrography (265 males and 578 females, aged 1 week to 12 years, mean age 2 years) were performed during a period of 4 years. The conventional standard procedure was applied. In 3 cases with passed history of urinary tract infection the catheter entered directly into the ureter. In all these cases the uretero-vesical reflux was present on the same side where the catheter entered. It appears that insertion of a catheter into the ureter is possible only in the presence of an anomaly or pathology at the vesicoureteric junction.

Child, Preschool↗
PubMed2001

Minimal pelvic fluid in blunt abdominal trauma in children: the significance of this sonographic finding.

PURPOSE: The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid after blunt abdominal trauma in children as a predictor of an abdominal organ injury. METHODS: The clinical and imaging data of 183 children with blunt abdominal trauma were reviewed retrospectively. All children had an abdominal sonography as the primary screening study. The ultrasound results were divided into 3 groups: group A, normal examination; group B, pelvic fluid only; group C, peritoneal fluid outside the pelvis. The results of the initial ultrasound examinations were compared with the findings of the CT scan, or a second ultrasound examination or the clinical course during the hospitalization. RESULTS: Group A included 87 children; group B, 57, and group C, 39. Four abdominal organ injuries were missed by the ultrasound examination. The sensitivity and specificity of the ultrasound examinations to predict organ injury in presence of peritoneal fluid outside the pelvis were, respectively, 89.5% and 96.6%; the positive and negative predictive value were 87.2% and 97.3%. No statistically significant difference was seen between group A and group B, whereas the presence of peritoneal fluid outside the pelvic cavity (group C) was associated strongly with an organ injury (P <.001). CONCLUSIONS: A normal ultrasound examination or the presence of pelvic fluid are associated with a low probability of an organ injury. In the presence of peritoneal fluid outside the pelvis, the probability of an organ injury is very high.

Abdominal Injuries↗
PubMed2001

Volvulus of the stomach in childhood: the spectrum of the disease.

INTRODUCTION: During a 5-year time frame, five cases of symptomatic gastric volvulus were diagnosed and treated in our department. Four presented with the acute form of gastric volvulus and underwent emergency surgery. The fifth suffered the chronic variant of the syndrome and was benefited by nonoperative management. The cases serve to remind emergency physicians of the spectrum of gastric volvulus. The report supplements the sparse clinical description in the emergency literature. RESULTS: In the operated patients, there were no postoperative complications. The outcome, to the time of publication, has been good in every instance. The history, etiology, presentation, and treatment of the disease are discussed in detail. CONCLUSIONS: Not infrequently, gastric volvulus in children fails to exhibit the full gamut of signs and symptoms such as abdominal distension, vomiting, pain, and retching. For this, as well as for other stated reasons, symptomatic gastric volvulus in infancy and childhood may not be as rare as is commonly assumed.

Acute Disease↗
PubMed2001

Ambulatory blood pressure monitoring in children with a solitary kidney - a comparison between unilateral renal agenesis and uninephrectomy.

BACKGROUND: In experimental animals, a reduction in renal mass leads to glomerulosclerosis of the residual parenchyma and eventual renal failure. In humans, however, data on the influence of nephrectomy or agenesis on future functional parameters and hypertension are as yet controversial. OBJECTIVE: To evaluate blood-pressure patterns in children with a solitary kidney as a result of either unilateral renal agenesis (URA) or uninephrectomy (UNX) and correlate them to the increase in size of the remaining kidney. METHODS: Twenty-eight children with a solitary kidney were divided into two groups: the URA group, with 18 subjects (13 male and five female, with a mean age of 9.6 +/- 3.9 years), and the UNX group, which contained 10 subjects (four male and six female, with a mean age of 14.0 +/- 2.7 years). The mean time since nephrectomy was 8.7 years. Each study group was assigned an age-, weight- and height-matched control group. In all subjects, ambulatory blood pressure monitoring was performed using the SpaceLabs model no. 90207. Daytime and night-time were defined as 0800-2200 h and 2200-0800 h, respectively. Urinalysis, serum creatinine and urea results were recorded for all the study group participants. The size of the remaining kidney was determined by ultrasound examination. The percentage increase in kidney size, as calculated from standard kidney-length-against-age nomograms was correlated to the percentage deviation from normal blood pressure values. RESULTS: The mean 24 h, daytime and night-time systolic blood pressure (SBP) readings were significantly higher in children in the URA group than in those in the corresponding control group (111.4 +/- 7.5 mmHg versus 106.9 +/- 6.7 mmHg, P < 0.004; 115.2 +/- 3.1 mmHg versus 110.7 +/- 3.4 mmHg, P < 0.004; and 105.2 +/- 2.6 mmHg versus 101.2 +/- 1.8 mmHg, P < 0.002, respectively). Daytime heart rate was found to be significantly reduced (84.4 +/- 5.2 versus 87.8 +/- 8.2 beats/min, P < 0.04). In the UNX group, 24 h mean, systolic and diastolic blood pressure (DBP), as well as heart rate, did not differ from control values. Daytime systolic and diastolic blood pressures were higher than those of the controls (119.8 +/- 4.0 mmHg versus 115.5 +/- 3.8 mmHg, P < 0.02; and 72.7 +/- 4.0 mmHg versus 70.0 +/- 11.0 mmHg, P < 0.02, respectively). Nocturnal dipping was present in all groups and was of equal magnitude in the corresponding control groups. The mean 24 h diastolic blood pressure load was significantly greater in URA patients than in controls (19.6 versus 10.8%, respectively, P < 0.01). In the UNX group, the blood pressure loads were similar to those of controls. The percentage increase in length of the remaining kidney was found to correlate positively with the percentage delta increase in both systolic and diastolic blood pressure. CONCLUSIONS: Compared with the age-, height- and weight-matched controls, the children with a solitary kidney caused by URA had an elevated mean 24 h SBP. In contrast, those with UNX had mean 24 h blood pressure values similar to those of their controls. A rise in SBP was, however, seen in both groups during the daytime hours. Thus, the presence of a solitary kidney, for whatever reason, may be pathogenetically linked to a raised blood pressure, and this linkage may be more pronounced in URA. The delta increase in size of the remaining kidney may serve as a prognostic indicator of blood pressure elevation.

Adolescent↗
PubMed2001

Pyelocalyceal diverticulum: the imaging spectrum with emphasis on the ultrasound features.

Clinical and imaging data of 11 patients with pyelocalyceal diverticulum were retrospectively examined. Four patients suffered from ipsilateral flank pain, one from recurrent urinary tract infection and the other six from unrelated symptoms. All patients underwent ultrasound as the initial imaging study. In two cases ultrasound was the only examination performed. Additional imaging studies were obtained in the other nine patients (abdominal radiography in six cases, intravenous urography (IVU) in five and CT in four). Ultrasound suggested the diagnosis of pyelocalyceal diverticulum in eight cases owing to the presence of echogenic and mobile material within the cyst-like lesion. In three cases the ultrasound appearance was similar and indistinguishable from a simple cyst and the diagnosis was made by another imaging study IVU in two cases and CT in one). We suggest that ultrasound examination is the best imaging method for the diagnosis of a pyelocalyceal diverticulum, and no further imaging modalities are required when mobile echogenic material is seen. In uncertain cases, another relatively inexpensive imaging study should be added such as abdominal radiography or IVU.

Abdominal Pain↗
PubMed2001

Ultrasound features of spermatic cord hydrocele in children.

The aim was to evaluate the value of ultrasound diagnosis of spermatic cord hydrocele as a cause of inguinal swelling or mass in children. Clinical and ultrasound (US) findings and surgical procedures of 27 children with spermatic cord hydrocele were reviewed. All children, except one, were referred for US because of suspected inguinal hernia, hydrocele or inguinal mass. In one child, the US examination was performed to confirm the diagnosis of a spermatic cord hydrocele. An encysted hydrocele was diagnosed in 24 out of 27 cases, whereas a funicular type of spermatic cord hydrocele was found in the remaining 3 cases. Internal septa were seen within the fluid mass in four patients. 23 children underwent surgical exploration that confirmed the US diagnosis. Three children with encysted-type hydrocele were only followed clinically and by US, and one was lost from follow-up. US examination is a very sensitive and accurate method for diagnosis of this entity and for exclusion of other lesions in this region.

Adolescent↗
PubMed2001

Eosinophilic cystitis in a 4-year-old boy: successful long-term treatment with cyclosporin A.

A 4-year-old Jewish boy presented with dysuria, urinary dribbling, increased urinary frequency, and new onset of diurnal enuresis. An infiltrating solid mass involving the entire bladder wall was found. Biopsy revealed "tumor-forming" eosinophilic cystitis, a rare bladder lesion of unclear cause. Antitoxocariasis treatment was unsuccessful. High-dose corticosteroids failed. The child's clinical condition and bladder sonographic findings continued to deteriorate. Treatment with cyclosporin A was given for 8 months, with a complete clinical, radiologic, and histopathologic cure and no side effects. Two years of follow-up showed a complete recovery.

Child, Preschool↗
PubMed2000

Progressive liver calcifications in neonatal coxsackievirus infection.

Coxsackievirus group B can cause a severe systemic disease in the perinatal period. Severe manifestations like meningitis, encephalitis, hepatitis, and myocarditis have been previously reported. A case of a twin neonate infected by coxsackievirus group B is described, who developed progressive extensive hepatic calcifications demonstrated by ultrasound and computed tomography with follow-up. Hepatic calcifications in coxsackievirus infection have not been previously reported.

Calcinosis↗
PubMed2000

The increase of renal pelvis dilatation in the fetus and its significance.

OBJECTIVE: To determine the effects of the changes in fetal renal pelvis dilatation on post-natal diagnosis and outcome. METHODS: Prenatal sonographic fetal renal anteroposterior diameters of > or = 4 mm in the second trimester, which persisted to > or = 7 mm in the third trimester, were the inclusion criteria. Fifty-six fetuses and 73 renal units with normal karotypes and a solitary sonographic finding of renal pyelectasis, which met the inclusion criteria, were followed, post-natally, until the age of 30 months. The neonates were categorized into three groups, according to their final diagnosis: No hydronephrosis, pelvi-ureteric junction obstruction and hydronephrosis from other causes. The neonates were also categorized according to their outcome: no treatment, follow-up only and surgical treatment. RESULTS: In 17 neonates (30.4%), and 19 renal units, the diagnosis of hydronephrosis was excluded post-natally. In 39 neonates (69.6%), and 54 renal units, an urinary tract pathology was confirmed. The dynamics of pyelectasis in the second and third trimesters of pregnancy differed significantly among the neonates when categorized according to the final diagnosis (P < 0.05), or according to outcome (P < 0.05). CONCLUSION: It is possible to predict, and distinguish between, long-term conservative and surgical treatments of renal pelvis dilatation in the third trimester of pregnancy.

Dilatation, Pathologic↗
PubMed1998

Idiopathic non-obstructive hypertrophic cardiomyopathy, vitamin B12 deficiency and gastric adenocarcinoma: an unreported association in a teenager.

UNLABELLED: A 14-year-old boy presented with anorexia and weakness whereon the diagnosis of dimorphic anaemia was made. An excellent response to iron and vitamin B12 was observed. In addition, the patient had non-obstructive hypertrophic cardiomyopathy. At endoscopy 2.5 years later, an adenocarcinoma was diagnosed and the patient underwent a high subtotal gastrectomy. To the best of our knowledge, this rare association has never been reported in children. CONCLUSION: We report a youngster with pernicious anaemia, associated with nonobstructive hypertrophic cardiomyopathy in whom gastric adenocarcinoma was found. Patients with pernicious anaemia are at greater risk of developing gastric carcinoma than the general population, therefore we recommend routine periodic gastroscopic surveillance in the paediatric population with pernicious anaemia.

Adenocarcinoma↗
PubMed1998

Internal jugular vein thrombosis in patients with ovarian hyperstimulation syndrome.

OBJECTIVE: To describe a case of bilateral internal jugular vein thrombosis complicating ovarian hyperstimulation syndrome (OHSS). DESIGN: Case report. SETTING: Internal medicine ward in a teaching hospital. PATIENT: A 28-year-old nulliparous woman undergoing IVF. INTERVENTION(S): Ultrasonographic Doppler of the neck veins was performed because of pain and swelling in the neck, and bilateral jugular vein thromboses were detected. Laboratory evaluation revealed activated protein C resistance caused by factor V Leiden mutation. Low-molecular-weight heparin (enoxaparin) was administered for the remainder of the pregnancy and for 6 weeks after delivery. MAIN OUTCOME MEASURE: Resolution of jugular venous thromboses documented by ultrasonographic Doppler and normal progression of pregnancy. RESULT(S): The patient delivered healthy twins at term. There were no complications arising from the jugular vein thromboses or the low-molecular-weight heparin treatment. CONCLUSION(S): Unusually located venous thrombosis should prompt an evaluation for a hypercoagulable state. The high prevalence (4%-7%) of factor V Leiden mutation in most Western populations and the mutation's potential contribution to thrombotic complications in OHSS suggest that screening for this abnormality in women undergoing IVF may be indicated.

Adult↗