ABSTRACT. Objective. To determine predictive factors for the presence of focal infiltrates in children with clinically suspected pneumonia in a pediatric emergency department.Methods. Children (1-16 years) with clinically suspected pneumonia were studied prospectively. The presenting features were compared between the children with and without focal infiltrates using 2 analysis, t test, and odds ratio with 95% confidence intervals. A multivariate prediction rule was developed using logistic regression.Results. A total of 570 were studied. Risk factors (odds ratio; 95% confidence interval) for the presence of focal infiltrates included history of fever (3.1; 1.7-5.3), decreased breath sounds (1.4; 1.0 -2.0), crackles (2.0; 1.4 -2.9), retractions (2.8; 1.0 -7.6), grunting (7.3; 1.1-48.1), fever (1.5; 1.2-1.9), tachypnea (1.8; 1.3-2.5), and tachycardia (1.3; 1.0 -1.6). We then used logistic regression to develop a candidate prediction rule for the variables of fever, decreased breath sounds, crackles, and tachypnea, which had an area under the receiver operating curve of 0.668. This rule had excellent sensitivity (93.1%-98%) yet poor specificity (5.7%-19.4%).Conclusions. Multiple predictive factors for children with suspected pneumonia have been identified. Patients with focal infiltrates were more likely in our study to have a history of fever, tachypnea, increased heart rate, retractions, grunting, crackles, or decreased breath sounds. A multivariate prediction rule shows promise for the accurate prediction of pneumonia in children. However, the prospective evaluation of this multivariate prediction rule in a clinical setting is still required. Pediatrics 2004;113:e186 -e189. URL: http://www.pediatrics.org/ cgi/content/full/113/3/e186; pneumonia, chest radiographs, children, predictive factors.ABBREVIATIONS. ED, emergency department; OR, odds ratio; CI, confidence interval.T he accurate diagnosis of pneumonia in children remains an important yet difficult clinical problem. The chest radiograph remains the diagnostic test of choice in tertiary care centers. Given that the decision to pursue a diagnostic chest radiograph in the context of suspected pneumonia is largely influenced by clinical predictors of pediatric pneumonia, it is important to have these determined accurately.The clinical findings of patients with radiographic pneumonia have been described previously in both adult and pediatric populations in developed countries. 1-6 Some studies limit themselves to very young children. [7][8][9] However, the number of pediatric patients studied with radiographic pneumonia has been small. [1][2][3][4][5] In 1997, an evidence-based review of the literature dealing with pediatric pneumonia was published by a group of pediatric infectious disease specialists and a microbiologist. 10 The authors concluded that the absence of the pulmonary cluster as defined by Leventhal 1 of respiratory distress, tachypnea, rales, and decreased breath sounds accurately excluded pneumonia. This specific recommendation was based on a st...

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This report describes a fetus with a large multiloculated cystic liver mass. Two small abdominal cysts were seen on ultrasound at 19 weeks of gestation but the patient was referred to us at 23 weeks, after the mass had grown to 8.0 × 5.6 × 7.0 cm, displacing intra-abdominal organs, heart and diaphragm. There was a small amount of ascites but no hydrops. There was polyhydramnios and a thick hyperechoic placenta. After detailed sonograms and MRI suggested the diagnosis of cystic mesenchymal hamartoma of the liver, cyst decompression was favored and consent was obtained. Unfortunately, absence of fetal cardiac activity was noted on the day of the planned intervention. Autopsy confirmed the diagnosis and demonstrated placental changes consistent with mesenchymal stem villous hyperplasia of the placenta. Large fetal cystic abdominal masses that compress the heart, lungs and other organs may benefit from prenatal decompression. This is the first report of cystic hamartoma of the liver apparent on second-trimester sonography, and the fourth time such a lesion is associated with fetal or neonatal death out of 11 cases diagnosed prenatally.

Neurological complications post transplant have been described with the use of calcineurin inhibitors. Although tacrolimus may be a better immunosuppressant than cyclosporine, its neurological side effects may be worse. Two children, living-related kidney transplant recipients, were treated with antibody induction, mycophenolate mofetil, prednisone, and tacrolimus. Soon after transplant, they each developed an encephalopathy, which when visualized by magnetic resonance imaging showed that it affected both white and grey matter of the brain. Although the encephalopathy was associated with the use of tacrolimus, there was a complete neurological recovery without cessation of the drug.

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Congenital epulis is an uncommon benign tumor that originates from the alveolar ridge in newborns. It is also known as congenital gingival granular cell tumor. Although there have been around 200 reports of its postnatal diagnosis, this oral tumor has rarely been diagnosed prenatally. We present fetal MRI and Doppler prenatal imaging of an infant with two congenital epulides (simultaneous involvement of superior and inferior maxillas).

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The treatment of malignant glial tumours remains a tremendous challenge despite decades of pre-clinical and clinical research. These tumours represent about 80% of all primary brain tumours, and have a universally unfavourable prognosis despite new radiotherapy protocols and chemotherapy regimens.1,2 Thus, research remains active in this field, and therefore commands for pre-clinical models that are valid and predictive. Many animal models, mostly using the rat, have been developed to simulate the behaviour of glioblastoma tumour cells and to study the impact of radiotherapy, 3 chemotherapy, This phenomenon is explained by enhancement of the brain around tumour, the extra-axial tumour growth, and a shrinking factor of 17% related to the fixation process. Nonetheless, the radiological tumour growth paralleled the histological samples. This technology is thus suitable to follow tumour growth in F98 implanted rats. Les images rehaussées en T1 surestimaient toujours la masse tumorale mesurée sur les coupes H&E. Ce phénomène s'explique par le rehaussement du tissu cérébral autour de la tumeur, la croissance tumorale extra-axiale et un facteur de contraction de 17% dû au processus de fixation. Néanmoins, la croissance tumorale observée à l'imagerie évoluait parallèlement à celle observée en anatomopathologie. Cette technologie convient donc au suivi de la croissance tumorale chez les rats porteurs d'un implant F98.