The data suggest that clinically silent gallstones in children and infants are associated with low rates of complications and can be managed conservatively, unless complications occur. Patients with sickle cell disease, spherocytosis, and elliptocytosis had high complication rates and required surgery more often.

Characteristic changes during epiphyseal union provide a skeletal age, which when compared with age-based standards provides an estimation of chronological age. Currently there are no data on epiphyseal union for the purposes of age estimation specific to an Irish population. This cross-sectional study aims to investigate the relationship between stage of epiphyseal union at the knee joint and chronological age in a modern Irish population. A novel radiographic method that sub-divides the continuum of development into five specific stages of union is presented. Anteroposterior and lateral knee radiographs of 148 males and 86 females, aged 9-19 years, were examined. Fusion was scored as Stage 0, non-union; Stage 1, beginning union; Stage 2, active union; Stage 3, recent union; or Stage 4, complete union. Stage of epiphyseal union is correlated with chronological age in both males and females. Mean age gradually increases with each stage of union and also varies between male and female subjects. A statistically significant difference in mean age was recorded between stages when compared to the previous stage, for the three epiphyses. Irish children are comparable to those from previously published studies with epiphyseal union in females occurring earlier than males. A significant difference was noted between the mean age of union for males and females for each of Stages 1 and 2 for the femur and Stages 0, 1, 2 and 3 for the tibia and the fibula. The results also suggest that the stages of union occur at earlier ages in this Irish population. Implementation of standardized methodology is necessary to investigate if this is due to a secular or population variation in maturation or to a methodology which clearly identifies five stages of union.

BackgroundStroke is the second most common cause of seizures in term neonates and is associated with abnormal long-term neurodevelopmental outcome in some cases.ObjectiveTo aid diagnosis earlier in the postnatal period, our aim was to describe the characteristic EEG patterns in term neonates with perinatal arterial ischaemic stroke (PAIS) seizures.DesignRetrospective observational study.PatientsNeonates >37 weeks born between 2003 and 2011 in two hospitals.MethodContinuous multichannel video-EEG was used to analyze the background patterns and characteristics of seizures. Each EEG was assessed for continuity, symmetry, characteristic features and sleep cycling; morphology of electrographic seizures was also examined. Each seizure was categorized as electrographic-only or electroclinical; the percentage of seizure events for each seizure type was also summarized.ResultsNine neonates with PAIS seizures and EEG monitoring were identified. While EEG continuity was present in all cases, the background pattern showed suppression over the infarcted side; this was quite marked (>50% amplitude reduction) when the lesion was large. Characteristic unilateral bursts of theta activity with sharp or spike waves intermixed were seen in all cases. Sleep cycling was generally present but was more disturbed over the infarcted side. Seizures demonstrated a characteristic pattern; focal sharp waves/spike-polyspikes were seen at frequency of 1–2 Hz and phase reversal over the central region was common. Electrographic-only seizure events were more frequent compared to electroclinical seizure events (78 vs 22%).ConclusionsFocal electrographic and electroclinical seizures with ipsilateral suppression of the background activity and focal sharp waves are strong indicators of PAIS. Approximately 80% of seizure events were the result of clinically unsuspected seizures in neonates with PAIS. Prolonged and continuous multichannel video-EEG monitoring is advocated for adequate seizure surveillance.

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We report a case of penetration of the inferior vena cava (IVC) by all four primary struts of a Celect caval filter in a 17-year-old girl with Klippel-Trénaunay syndrome. The girl presented with acute lower abdominal and right leg pain 17 days after filter insertion. An abdominal radiograph demonstrated that the filter had moved caudally and that the primary struts had splayed considerably since insertion. Contrast-enhanced CT confirmed that all four primary struts had penetrated the IVC wall. There was a small amount of retroperitoneal hemorrhage. The surrounding vessels and viscera were intact. The filter was subsequently retrieved without complication.

Physiotherapy and radiography of the joints are standard diagnostic strategies for assessment of haemophilic arthropathy. The use of ultrasonography as an adjunct tool for early diagnosis of haemophilic arthropathy may optimize factor replacement therapy. The objective of this study was to compare costs and effectiveness of physiotherapy, radiography and ultrasonography (intervention strategy, IS) with physiotherapy and radiography alone (standard care strategy, SCS) for diagnosing soft tissue and osteocartilaginous changes in haemophilic joints. We retrospectively compared costs and effectiveness of IS vs. SCS in knees, ankles and elbows of 31 children (age range, 4-17 years) with haemophilia A (n = 30) or B (n = 1) (IS, n = 11; SS, N = 20). Direct health care costs were measured from the provincial health care perspective. Effectiveness was measured by false-negative (FN) rates in each study arm by comparing presence or absence of abnormalities of physiotherapy and imaging exams to the reference standard measure (MRI). In scenario 1, all diagnostic tests matched with MRI. In scenario 2, at least one diagnostic test matched with MRI. The IS was more costly [incremental cost/100 patients, Canadian (CND) $4987] and more effective (incremental effectiveness, FNs/100 patients for scenario 1, -4.09, and for scenario 2, -41) for both scenarios. The incremental cost-effectiveness ratios for scenario 1 and for scenario 2 were CND$1166 and CDN$116 per FN result averted per 100 patients, respectively. In conclusion, in the short-term, the incorporation of ultrasonography in a test set for diagnosis of haemophilic arthropathy substantially improved the diagnostic performance of this test set, however at an increased cost.

BackgroundDespite limitations of routine methods, Clinical Practice Guidelines support the assessment of bone mineral density (BMD) and vascular calcification in renal transplant recipients. Changes in fat mass also occur post-transplantation, although they are traditionally difficult to measure accurately. We report the feasibility, convenience and accuracy of measuring the above 3 parameters using a novel CT protocol.MethodsWe conducted a cross-sectional study of 64 first renal allograft recipients (eGFR > 30 ml/min/1.73 m2). Quantitative CT (QCT) BMD analysis was conducted using CT lumbar spine (GE Medical Systems Lightspeed VCT & Mindways QCT Pro Bone Mineral Densitometry System Version 4.2.3) to calculate spinal volumetric BMD and compared with standard DXA calculated areal BMD at the spine, hip and distal forearm. Abdominal aortic calcification was assessed by semi-quantitative Aortic Calcification Index (ACI) method and compared with lateral lumbar x-ray Kappuila score and pulse wave velocity (PWV). Visceral and subcutaneous adipose tissue volume (Osirix 16 Ver 3.7.1) was compared with BMI.ResultsParticipants were 61 % male, had a mean age of 47 years, median ESKD duration of 5.4 years and a mean eGFR of 54 ml/min. iDXA median T-score at proximal femur was −1.2 and at lumbar spine was −0.2. Median QCT Trabecular T-score at lumbar spine was −1.2. The percent of subjects with a T-score of <2.5 by site and method was DXA Proximal Femur: 7 %, DXA distal radius: 17 %, DXA spine: 9 %, QCT (American College of Radiology cutoffs): 9 %. CT derived ACI correlated with PWV (r = 0.29, p = 0.02), pulse wave pressure (r = 0.51, p < 0.001), QCT Trabecular (−0.31, p = 0.01) and cortical volumetric BMD and history of cardiovascular events (Mann–Whitney U, p = 0.02). Both visceral and subcutaneous adipose tissue correlated with BMI (r = 0.63 & 0.64, p < 0.001).ConclusionsSingle CT scan triple assessment of BMD, vascular calcification and body composition is an efficient, accurate and convenient method of risk factor monitoring post renal transplantation.

Perinatal stroke is the second most common cause of neonatal seizures, and can result in long-term neurological impairment. Diagnosis is often delayed until after seizure onset, owing to the subtle nature of associated signs. We report the early electroencephalographic (EEG) findings in a female infant with a perinatal infarction, born at 41 weeks 2 days and weighing 3.42kg. Before the onset of seizures, the EEG from 3 hours after delivery demonstrated occasional focal sharp waves over the affected region. After electroclinical seizures, focal sharp waves became more frequent, complex, and of higher amplitude, particularly in 'quiet sleep'. In 'active sleep', sharp waves often disappeared. Diffusion-weighted imaging confirmed the infarct, demonstrating left frontal and parietal diffusion restriction. At 9 months, the infant has had no further seizures, and neurological examination is normal. To our knowledge, this report is the first to describe the EEG findings in perinatal stroke before seizures, and highlights the evolution of characteristic background EEG features.Perinatal stroke is an important cause of long-term neurological morbidity, 1 and the second most common cause of seizures in the newborn period, accounting for 12 to 18% of all neonatal seizures.2,3 Most infants who suffer a stroke are well after delivery, and come to attention when they develop clinical seizure activity.2 Therefore, electroencephalography (EEG) is generally performed only after presentation with seizures. EEG can monitor ongoing seizure activity, aid diagnosis, and predict outcome. 4 The EEG features associated with neonatal stroke have been described only peri-or postictally. The early EEG changes that occur before the onset of clinical seizures in neonatal stroke are unknown. We present the early clinical and EEG findings from 3 hours after delivery in a term infant with a middle cerebral artery infarct who progressed to seizures at 33 hours post delivery. Parental informed consent was obtained for publication of this case report. CASE REPORTA female infant was born at 41 weeks 2 days to a 34-year-old mother whose pregnancy had been uneventful. The antenatal fetal heart rate and variability were normal. The infant was delivered by ventouse owing to failure to progress. Meconium was present at delivery, and the airway was intubated and aspirated. Positive-pressure ventilation was required for 2 minutes. The heart rate remained over 100 beats per minute throughout. The Apgar scores were 3 at 1 minute and 6 at 5 minutes. The arterial cord pH was 7.27, with a base excess of )7.6mEq ⁄ L and bicarbonate of 19.3mmol ⁄ L.The infant was admitted to the neonatal unit with mild tachypnoea requiring 30% fractional inspired oxygen (F i O 2 ) for 6 hours. A chest radiograph was consistent with mild meconium aspiration, and neurological examination at this time was normal. As part of an ongoing research study, continuous digital video EEG began at 3 hours post delivery.The infant stabilized quickly, and at 18 hours post-delivery EEG was disco...