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We report a case of late type III B endoleak from a fabric tear in the main body of a Zenith bifurcated stent-graft approximately 19 months after implantation. A follow-up computed tomography (CT) scan showed gradual growth in the size of the aneurysm, but no apparent endoleak was recognized. However, the CT scan had demonstrated a mosaic pattern in the aneurysm sac, which could indicate an endoleak from a fabric tear. The defect was repaired by implantation of body extensions, but the patient died 5 h after the procedure.

Aim Intraosseous access is an alternative to conventional intravenous access. A number of studies have demonstrated the utility and safety of EZ‐IO, a recently introduced semi‐automatic intraosseous device. However, few studies have investigated the use of EZ‐IO in the paediatric emergency setting. The aim of this study was to describe the epidemiological characteristics EZ‐IO use including complications among paediatric patients in a paediatric emergency department. Methods We conducted a retrospective descriptive study enrolling children younger than 16 years who visited our emergency department between January 2013 and August 2018. Data on age, gender, diagnosis, insertion success rate and complications were collected and analysed. Results Seventy‐two patients were enrolled; of these 38 (52.8%) were male. The median age was 9 months (interquartile range: 3–34.5 months). Of the total, 22 (30.6%) received more than one IO insertion. Ninety‐seven consecutive IO insertions were identified. The rate of successful insertions was achieved at 92.7% (90 insertions). There were 21 complications (21.6%), including 17 extravasations (17.5%) of fluid and four dermal abrasions (4.1%). We found no cases of complications that may have compromised patient safety. Conclusions The success rate of the EZ‐IO insertion was high in paediatric patients. However, we found a higher incidence of dermal abrasions, which might be a complication specific to children.

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BackgroundPrevious studies have examined the utility of ultrasonography performed by radiologists for diagnosing paediatric testicular torsion. While point-of-care ultrasound (POCUS) is used in paediatric emergency medicine, its diagnostic accuracy is still unknown.ObjectivesThe present systematic review and meta-analysis aimed to clarify the accuracy of POCUS in diagnosing testicular torsion in children.MethodsFollowing the Preferred Reporting Items for Systematic Review and Meta-analysis of Diagnostic Test Accuracy guidelines, a systematic review was performed using the indices of MEDLINE, EMBASE plus EMBASE classics, PubMed and the Cochrane database from inception to November 2020. Any study investigating the diagnostic accuracy of POCUS for paediatric testicular torsion was extracted. The primary outcome was the assessment of the diagnostic accuracy of POCUS for paediatric testicular torsion. The pooled sensitivity and specificity were calculated. Quality analysis was conducted using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).ResultsFour studies enrolling 784 patients in total were included. The pooled sensitivity, specificity, and positive and negative likelihood ratios of POCUS were 98.4% (95% CI: 88.5% to 99.8%), 97.2% (95% CI: 87.2% to 99.4%), 34.7 (95% CI: 7.4 to 164.4) and 0.017 (95% CI: 0.002 to 0.12), respectively. Risk-of-bias assessment using QUADAS-2 revealed that two of the studies had a high risk of bias in patient selection.ConclusionThe present systematic review and meta-analysis showed that POCUS had high sensitivity and specificity for identifying testicular torsion in paediatric patients although the risk of bias was high in the studies analysed.

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Background Febrile young infants have a high risk of serious infection. Although measuring vital sign parameters can serve as a rapid and effective assessment in these patients, their predictive value for serious bacterial infection (SBI) has not been fully investigated. Methods This retrospective observational study enrolled febrile (>38.0°C) infants aged <90 days at the time of presentation. Data from the emergency room triage database at Tokyo Metropolitan Children's Medical Center for the period 1 November 2011–30 November 2013, were reviewed. Variables included patient age, gender, and vital sign data, including body temperature, pulse rate, oxygen saturation, definitive diagnosis, and disposition. Results Two hundred and sixty‐nine patients were included, with a mean age of 55 days, and 158 (58.7%) were male. Of the total, 43 patients had an SBI. On logistic regression, body temperature ≥38.5°C (OR, 2.80; 95%CI: 1.37–5.74) was a significant predictor of SBI. Conclusion High‐grade fever was found to be a significant predictor of SBI in febrile young infants.

There was a significant change in the neck angle between the preoperative condition and the immediate postoperative condition. However, there was no clear relationship found between the angle of the neck and the proximal stent-graft migration. Postoperative changes in the proximal neck angle just after EVAR and subsequent temporal changes during a 2-year follow-up period do not appear to predict stent-graft migration, secondary intervention rates, or the occurrence of endoleak.