No abstract
This review presents techniques to optimize bone scintigraphy for evaluation of the spectrum of abnormalities associated with pediatric osteomyelitis, with an emphasis on the approaches to patient preparation and positioning and to interpretation. The diagnosis of pediatric osteomyelitis can be challenging for several different reasons. Bone scintigraphy is especially useful when the site of osteomyelitis is unclear. Other imaging modalities, including radiography, ultrasonography, and magnetic resonance imaging, all have advantages and may have a role in evaluating the condition of the child with osteomyelitis. Pathophysiologic considerations unique to children contribute to a different clinical presentation of osteomyelitis in the pediatric population than that seen in adults. In addition, patient movement degrades image quality substantially, which is an important consideration for imaging children. Neonates have a higher incidence of multifocal osteomyelitis, and they represent a unique subset of the pediatric population with separate considerations. Several examples illustrate techniques to optimize imaging, as well as show the spectrum of abnormalities associated with pediatric osteomyelitis. Careful attention to bone scintigraphic technique ensures that high-quality images can be obtained, which will allow confident diagnosis of pediatric osteomyelitis.
This study shows a directly proportional relationship between blood glucose levels and nonpathologic (18)F-FDG biodistribution in the right and left hepatic lobes. The influence of blood glucose on expected biodistribution patterns, particularly in the liver, should be considered during interpretation.
One hundred children with hyperkinesis and cerebral dysfunction were given individual three-day trials of pharmacologic doses of thiamin, calcium pantothenate, pyridoxine, and placebo. When beneficial response was noted, a second week-long trial of vitamins was given, alternating with placebo, followed by long-term therapy. Two-thirds of the remaining children not responding to this schedule were then given pharmacologic doses of niacinamide, combinations of B-complex vitamins, or elimination diets. Eight children dramatically responded to pharmacologic doses of thiamin, of which four still require the vitamin either intermittently or continuously after four years. Nine children responded to 300 mg of pyridoxine; an additional 5 patients responded only after receiving larger doses. Only one child could be maintained on placebo. In subsequent trials, 11 responded to niacin or to combinations of B-complex vitamins with minerals. In a two-year follow-up, six children who had demonstrated no beneficial response to these clinical trials had spontaneously improved. Eight children responded to dietary manipulations alone. Half the children found to be “dependent” on pharmacological doses of thiamin worsened with administration of B6. Conversely, half of the pyridoxine responders worsened when given large doses of thiamin. Blood zinc levels dropped substantially with administration of pyridoxine. The experience suggests that the hyperkinetic cerebral dysfunction syndrome is multifactoral. A significant number are caused by vitamin deficiency or pharmacologic dependency.
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