Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals with predisposing conditions. The aim of this study was to evaluate the community-acquired enterococcal UTIs in otherwise well children. We reviewed all the 257 first UTI episodes in children hospitalized in a General Hospital during a 5-year period. Enterococcus faecalis was isolated in 13 episodes, accounting for 5.1% of the total UTIs. All strains were susceptible to ampicillin, vancomycin and nitrofurantoin. Imaging studies revealed major urinary tract abnormalities in 9 and parenchymal defects in 8 children. During a follow-up period from 2 to 6 years, 4 children suffered break-through infections despite antibiotic prophylaxis, 3 developed renal scarring and 4 underwent corrective surgical procedures. Children with enterococcal UTIs presented with significantly higher rates of anatomical abnormalities and worse prognosis in terms of renal scarring, recurrences and corrective surgery compared with the total cohort of children with Gram-negative UTIs. However children with enterococcal UTIs did not present with a worse prognosis when compared with a group of children with Gram-negative UTIs matched for age and degree of reflux. Enterococcal infection is not an independent risk factor for poor outcome, nevertheless positive urine culture including enterococci is highly indicative for underlying urinary tract abnormalities, recurrences, renal scarring, and need for surgical intervention.
Although individual sonographic signs are not specific, the categorization and combination of findings might be highly suggestive of diagnosis of the underlying disease presenting with cervical lymphadenopathy.
Magnetic resonance imaging of pituitary hyperplasia has been rarely described in children with primary hypothyroidism. We report a case of pituitary hyperplasia in a child presented with significant growth arrest and laboratory evidence of hypothyroidism. Magnetic resonance imaging revealed symmetrical pituitary enlargement simulating macroadenoma. After thyroid hormone replacement therapy, the child's height increased and pituitary enlargement regressed to normal. Awareness of MRI appearance of pituitary hyperplasia in children with laboratory evidence of hypothyroidism might avoid misdiagnosis for pituitary tumor, which may also manifest as growth disorder, obviating unnecessary surgery.
The aim of this study was to assess whether contrast-enhanced ultrasound (CE-US) could provide improved diagnostic information in detecting liver metastases from colorectal cancer as compared to B-mode non-enhanced ultrasound (B-US). 32 patients (M/F 23/9, age range 48–82 years, mean 58.2 years) under chemotherapy for colorectal cancer were examined with B-US and CE-US using a second-generation ultrasound contrast agent and a dedicated protocol for contrast detection. The presence of focal liver lesions along with the number, size, pre- and post-contrast sonographic features were recorded digitally. Lesion conspicuity with a three-grade scoring scale was performed on both techniques and contrast intensity measurements were calculated for each focal lesion. CE-US detected 17% more metastases in patient-by-patient and lesion-by-lesion analysis. A statistically significant difference was found between the scoring mean values with regard to conspicuity of the lesions. Accurate characterization of the liver lesions was achievable only with contrast-enhanced technique. A quantitative contrast intensity measurement method confirmed the invariably washing-out vascular pattern in all metastases at sinusoidal-parenchymal liver phase. In conclusion, CE-US is superior to B-US and provides an effective tool in the investigation of colorectal cancer liver metastases.
Although individual sonographic signs are not specific, the categorization and combination of findings might be highly suggestive of diagnosis of the underlying disease presenting with cervical lymphadenopathy.
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