scholarly journals Role of ultrasound in the diagnosis of paediatric acute osteomyelitis

2021 ◽  
Vol 21 (84) ◽  
pp. e34-e40
Author(s):  
Amit Kumar Paliwal ◽  
◽  
Ravinder Sahdev ◽  
Ankur Deshwal ◽  
Birma Ram ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Fluid Collection ◽  
Paediatric Population ◽  
Radiographic Examination ◽  
Tissue Fluid ◽  
Acute Osteomyelitis ◽  
Mri Findings ◽  
Treatment Protocols ◽  
Paediatric Patients ◽  
The Right

Aim: The aims of our study were to evaluate cases of extremity pain or swelling in paediatric patients using USG to diagnose acute osteomyelitis, and correlate USG findings with MRI findings. Material and methods: 18 paediatric patients with extremity pain or swelling were evaluated. After the clinical and laboratory work-up, imaging was done using radiographic examination, USG and MRI of the affected limb. Results: 5 patients (27.8%) out of 18 were diagnosed with acute osteomyelitis based on USG findings, confirmed by MRI and surgical drainage. The mean age of the patients with acute osteomyelitis was 8.2 years. Male children were more commonly affected as compared to female. The distal metaphysis of the femur was the most common site involved (80%). The right lower limb was more commonly affected. The most frequent presentation was pain at the affected site. On USG, deep soft tissue fluid collection around the bone was present in all cases (100%). Periosteal thickening or elevation with subperiosteal fluid collection was seen in 4 cases (80%). Increased vascularity within or around the periosteum on colour Doppler was seen in 4 cases (80%). Conclusions: Acute osteomyelitis is a common entity in the paediatric population, presenting with acute limb pain and swelling. Early diagnosis and management of acute osteomyelitis are essential to prevent serious complications. USG can play an important role in the early diagnosis of paediatric acute osteomyelitis, and should be incorporated into the treatment protocols followed in cases of suspected acute osteomyelitis. MRI should be reserved as problem-solving tool.

scholarly journals Acetazolamide and SGLT2 inhibitor as potent drugs for a patient with diabetes mellitus and worsening chronic lymphedema: A case report

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Hajime Kataoka
Keyword(s):  
Body Weight ◽  
Fluid Collection ◽  
Sglt2 Inhibitor ◽  
Chloride Concentration ◽  
Tissue Fluid ◽  
Fat Deposits ◽  
Serum Chloride ◽  
The Right ◽  
Chronic Lymphedema

Treatment of lymphedema using a pharmacologic approach is reported to have limited efficacy. Here, I report a patient with type 2 diabetes (T2DM) and acute worsening of her chronic lymphedema, in whom treatment with acetazolamide and a sodiumglucose cotransporter-2 inhibitor (SGLT2i) effectively improved the lymphedema. A 94-year-old woman, who was treated for T2DM, hyperlipidemia, and hypertension for 17 years at my hospital presented to the emergency room because of acute worsening of her chronic right leg lymphedema with increased swelling, tightness, and dull aching. A pharmacologic approach was used to treat her worsening lymphedema. Acetazolamide 500 mg/d was administered to treat the acute tissue fluid collection in the right lymphedematous leg. Ten days later, the patient’s body weight was markedly reduced by 3.2 kg, pitting in the right leg was markedly improved, and the circumference of right limb was decreased. On day 11, the glucose-lowering agent vildagliptin was switched to the SGLT2i empagliflozin 10 mg/d. On day 70, her body weight had decreased further by 2.8 kg, and the circumference of her right limb was greatly reduced compared with that under treatment with acetazolamide. Her serum chloride concentration was increased after treatment, but her hemoglobin and hematocrit values did not change during the study period. In conclusion, acetazolamide and an SGLT2i have acute diuretic effects for draining the excess tissue fluid in the lymphedematous limb without vascular contraction by enhancing vascular tonicity. Additionally, an SGLT2i may have chronic effects for reducing fat deposits in the lymphedematous limb.

scholarly journals Mandibular Symmetrical Bilateral Canine-Lateral Incisors Transposition: Its Early Diagnosis and Treatment Considerations

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Yehoshua Shapira ◽  
Tamar Finkelstein ◽  
Rana Kadry ◽  
Shirley Schonberger ◽  
Nir Shpack
Keyword(s):  
Early Diagnosis ◽  
Mixed Dentition ◽  
Lateral Incisor ◽  
Radiographic Examination ◽  
Dental Arch ◽  
Mandibular Tooth ◽  
Distal Migration ◽  
Treatment Considerations ◽  
Mandibular Canine ◽  
The Right

Bilateral mandibular tooth transposition is a relatively rare dental anomaly caused by distal migration of the mandibular lateral incisors and can be detected in the early mixed dentition by radiographic examination. Early diagnosis and interceptive intervention may reduce the risk of possible transposition between the mandibular canine and lateral incisor. This report illustrates the orthodontic management of bilateral mandibular canine-lateral incisor transposition. Correct positioning of the affected teeth was achieved on the left side while teeth on the right side were aligned in their transposed position. It demonstrates the outcome of good alignment of the teeth in the dental arch.

scholarly journals Hypo-hyperdontia: a case report

2015 ◽  
Vol 63 (3) ◽  
pp. 331-336
Author(s):  
Henrique Castilhos RUSCHEL ◽  
Michelle DIAMANTE ◽  
Paulo Floriani KRAMER
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Mixed Dentition ◽  
Radiographic Examination ◽  
Surgical Removal ◽  
Dental Practice ◽  
Supernumerary Teeth ◽  
Supernumerary Tooth ◽  
Adequate Treatment ◽  
The Right

The occurrence of hypodontia (absence of teeth) and hyperdontia (presence of supernumerary teeth) in the same patient is a rarely seen condition in dental practice. Early diagnosis and adequate treatment are very important when addressing this abnormality in the mixed dentition. The approach will depend on the severity of the case and the timing of diagnosis. This paper reports the case of an 11-year-old patient with absence of the permanent maxillary lateral incisors and the mandibular second premolars, with concomitant presence of a supernumerary tooth in the region of the right mandibular lateral incisor. Based on physical and radiographic examination findings, a diagnosis of hypo-hyperdontia was made. The diagnostic and therapeutic management of the case is discussed. The treatment adopted was surgical removal of the supernumerary teeth and esthetic restoration to transform the permanent mandibular canines into lateral incisors.

Ameloblastic Fibroma Associated With Impacted 3rd Molar: A Case Report

2017 ◽  
Vol 1 (7) ◽  
pp. 18-21
Author(s):  
K Indira Priyadarshini ◽  
Karthik Raghupathy ◽  
K V Lokesh ◽  
B Venu Naidu
Keyword(s):  
Relative Frequency ◽  
Posterior Region ◽  
Radiographic Examination ◽  
Dental Eruption ◽  
Ameloblastic Fibroma ◽  
Odontogenic Origin ◽  
The Common ◽  
The Times ◽  
The Right ◽  
Slow Growing

Ameloblastic fibroma is an uncommon mixed neoplasm of odontogenic origin with a relative frequency between 1.5 – 4.5%. It can occur either in the mandible or maxilla, but predominantly seen in the posterior region of the mandible. It occurs in the first two decades of life. Most of the times it is associated with tooth enclosure, causing a delay in eruption or altering the dental eruption sequence. The common clinical manifestation is a slow growing painless swelling and is detected during routine radiographic examination. There is controversy in the mode of treatment, whether conservative or aggressive. Here we reported a 38 year old male patient referred for evaluation of painless swelling on the right posterior region of the mandible associated with clinically missing 3rd molar. The lesion was completely enucleated under general anesthesia along with the extraction of impacted molar.

Prerequisites to support high-quality clinical trials in children and young people

2020 ◽  
pp. archdischild-2019-318677
Author(s):  
Steven Hirschfeld ◽  
Florian B Lagler ◽  
Jenny M Kindblom
Keyword(s):  
Clinical Trials ◽  
Healthcare Delivery ◽  
Paediatric Population ◽  
Ecosystem Functions ◽  
Healthcare Delivery System ◽  
High Quality ◽  
Children And Young People ◽  
The Right ◽  
Support Decision Making

Children have the right to treatment based on the same quality of information that guides treatment in adults. Without the proper evaluation of medicinal products and devices in paediatric clinical trials that are designed to meet the rigorous standards of the competent authorities, children are discriminated from advances in medicine. There are regulatory, scientific and ethical incentives to address the knowledge gap regarding efficacy and safety of medicines in the paediatric population. High-quality clinical trials involving children of all ages can generate data that will ultimately close the knowledge gaps and support decision making.For clinical trials that enrol children, the needs are specialised and often resource intensive. Prerequisites for successful paediatric clinical trials are personnel with training in both paediatrics and neonatology and expertise in clinical trials in these populations. Moreover, national and international networks for efficient collaboration, dissemination of information, and sharing of resources and expertise are also needed, together with competent, efficient and high-quality local infrastructure with effective processes. Monitoring and oversight bodies with the relevant competence, including expertise in paediatrics, is also an important prerequisite for paediatric clinical trials. Compromise in any of these components will compromise the downstream results.This paper discusses the structures and competences needed in order to perform effective, high-quality paediatric clinical trials with the ultimate goal of better medicines and treatments for children. We propose a model of examining the process as a series of components that each has to be optimised, then all the components are actively optimised to function together as an ecosystem, and the resulting ecosystem functions well with the general research system and the healthcare delivery system.

Neuroimaging of Children With Takayasu Arteritis

2021 ◽  
pp. 088307382199128
Author(s):  
Hafize Emine Sönmez ◽  
Ferhat Demir ◽  
Semanur Özdel ◽  
Şerife Gül Karadağ ◽  
Esra Bağlan ◽  
...  
Keyword(s):  
Takayasu Arteritis ◽  
Internal Carotid ◽  
Laboratory Data ◽  
Left Middle Cerebral Artery ◽  
Mri Findings ◽  
Cranial Mri ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
And Diffusion ◽  
Left Middle

Objective: Takayasu arteritis is a rare granulomatous chronic vasculitis that affects the aorta and its main branches. Neurologic manifestations can accompany the disease; however, there is no study on neuroimaging in children with Takayasu arteritis. Therefore, we aimed to evaluate cranial magnetic resonance imaging (MRI) in pediatric Takayasu arteritis patients. Materials and Methods: Demographic, clinical, and laboratory data were obtained retrospectively. Results: The study included 15 pediatric Takayasu arteritis patients. All patients presented with constitutional symptoms. Additionally, 6 patients suffered from headache, 2 had syncope, 1 had loss of consciousness, and 1 had convulsion. All patients underwent cranial and diffusion MRI a median 12 months after diagnosis. Cranial MRI findings were normal in 12 patients, whereas 3 patients had abnormal findings, as follows: stenosis in the M1 and M2 segments of the left middle cerebral artery (n = 1); diffuse thinning of the right internal carotid, middle cerebral, and right vertebral and basilar artery (n = 1); as a sequela, areas of focal gliosis in both the lateral ventricular and posterior periventricular regions (n = 1). Among these 3 patients, 1 had no neurologic complaints. Conclusion: Abnormal MRI findings can be observed in pediatric Takayasu arteritis patients, even those that are asymptomatic; therefore, clinicians should carefully evaluate neurologic involvement in all pediatric Takayasu arteritis patients.

Sonographic Diagnosis of Bilateral Tubal Pregnancies

2021 ◽  
pp. 875647932199235
Author(s):  
Amber R. Matuzak
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Tubal Ligation ◽  
Tubal Pregnancy ◽  
Rare Form ◽  
Sonographic Diagnosis ◽  
Ectopic Pregnancies ◽  
The Right ◽  
Preoperative Sonography ◽  
Bilateral Tubal Pregnancy

Bilateral tubal pregnancy (BTP) is a very rare form of ectopic twin gestation. Many times, they occur after the use of assisted reproductive therapy. Most cases of BTP are diagnosed during laparoscopy. This case report demonstrates a rare preoperative, sonography diagnosis of a spontaneous BTP which occurred after a tubal ligation. The sonogram revealed two corpus luteal cysts, both located on the right ovary, which suggests that the left tubal pregnancy most likely occurred as a result of ovum transmigration. This case demonstrates the important role that sonography plays in the early diagnosis of ectopic pregnancies as well as the importance of thoroughly examining the entire pelvis during a pelvic sonogram.

scholarly journals Levator palpabrae superioris myositis as an unusual cause of unilateral ptosis—case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ahmed M. Abdrabou
Keyword(s):  
Previous History ◽  
Good Prognosis ◽  
Oculomotor Nerve Palsy ◽  
Ophthalmological Examination ◽  
Bilateral Ptosis ◽  
Mri Findings ◽  
Upper Eyelid ◽  
Unilateral Disease ◽  
The Right ◽  
Mri Study

Abstract Background Ptosis can be a manifestation of a more serious situation. Hence, the analysis of the complaint and the search for etiology are crucial in such cases. Ptosis has many causes; some of them lead to unilateral ptosis while others cause bilateral ptosis. For instance, myasthenia gravis is a cause of bilateral ptosis while oculomotor nerve palsy induces unilateral disease. Proper evaluation of the patient and identification of the cause are important to achieve accurate management and good prognosis. Case presentation A 47-year-old male patient attended the ER complaining of dropping the right eye lid of 2 days’ duration. There was no associated pain or diplopia. On examination, the extraocular muscles’ (EOM) motility was intact, normal pupil and corneal reflexes, and there was swelling of the upper eyelid. Ophthalmological examination revealed normal anterior and posterior chambers as well as the vitreous and retina. The patient had a previous history of traumatic intracranial hemorrhage that was resolved without surgical intervention. He also had diabetes mellitus and hypertension. The patient was transferred to the MRI unit to perform MRI study of the brain and orbit with MRA and IV contrast administration. MRI findings confirmed the diagnosis of LPS myositis, and the patient received medical treatment and improved. Conclusion Proper radiological diagnosis leads to accurate management and achieves rapid recovery and optimal patient care.

Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review

2020 ◽  
Vol 46 (08) ◽  
pp. 895-907
Author(s):  
Nina D. Anfinogenova ◽  
Oksana Y. Vasiltseva ◽  
Alexander V. Vrublevsky ◽  
Irina N. Vorozhtsova ◽  
Sergey V. Popov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Transesophageal Echocardiography ◽  
Three Dimensional ◽  
Right Atrial ◽  
Treatment Protocols ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Right

AbstractPrompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.

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