Diagnostic Tool In Children Research Articles

13C mixed triglyceride breath test: a noninvasive method to assess lipase activity in children.

Results from the 13C mixed triglyceride (MTG) breath test correlate with duodenal lipase activity in adults. This noninvasive test is a potential screening and diagnostic tool for children with fat malabsorption. The aim of this study was to adapt the methodology of the MTG breath test to study test meals and sampling methods and to define normal values for healthy children of all age groups; premature and full-term infants have similar pancreatic lipase deficiencies. After parental consent was obtained, 12 premature infants (< 37 weeks gestation and with body weights > 2 kg), 12 full-term infants (1-6 months old), 20 children (3-10 years old), and 20 teenagers (11-17 years old) were tested. All children were thriving well, had no gastrointestinal or respiratory problems, and had not received any medication that contained natural 13C. For the premature and full-term infants, a formula was prepared that had a low and stable natural 13C content mixed with 100 mg 13C-labeled MTG (1,3-distearyl, 2-[13C-carboxyl] octanoyl glycerol) and 1 g polyethylene-glycol 3350. The best accepted test meal for children over 3 years old was a slice of white bread with 5 g butter and 15 g chocolate paste, mixed with 250 mg 13C-labeled MTG, and a glass of 100 mL whole-fat milk. Children over 3 years old were able to blow through a straw in a vacutainer for collecting the breath samples. In children under 3 years old, expired air was collected by aspirating breath via a nasal prong. Carbon dioxide production was calculated according to weight, age, and sex. For healthy pediatric control participants, the mean values for cumulative excretion of 13CO2 as a percentage of the administered dose after 6 hours were 23.9 +/- 5.2% in premature infants, 31.9 +/- 7.7% in full-term infants, 32.5 +/- 5.3% in children, and 28.0 +/- 5.4% in teenagers. The mean value for healthy adults is 35.6% with a lower reference limit of 22.8%. Age-specific test meals and breath-sampling techniques for the MTG breath test were defined. The mean values for different age groups may serve as guidelines for normal values in the pediatric population. The cumulative values for expired 13CO2 were above the lower limit for adults, which suggests that preduodenal lipases compensates for pancreatic lipase deficiency in premature and full-term infants.

13 C Mixed Triglyceride Breath Test: A Noninvasive Method to Assess Lipase Activity in Children

ABSTRACTBackgroundResults from the 13 C mixed triglyceride (MTG) breath test correlate with duodenal lipase activity in adults. This noninvasive test is a potential screening and diagnostic tool for children with fat malabsorption. The aim of this study was to adapt the methodology of the MTG breath test to study test meals and sampling methods and to define normal values for healthy children of all age groups; premature and full‐term infants have similar pancreatic lipase deficiencies.MethodsAfter parental consent was obtained, 12 premature infants (&lt; 37 weeks gestation and with body weights &gt; 2 kg), 12 full‐term infants (1–6 months old), 20 children (3–10 years old), and 20 teenagers (11–17 years old) were tested. All children were thriving well, had no gastrointestinal or respiratory problems, and had not received any medication that contained natural 13 C. For the premature and full‐term infants, a formula was prepared that had a low and stable natural 13 C content mixed with 100 mg 13 C‐labeled MTG (1,3‐distearyl, 2‐[ 13 C‐carboxyl] octanoyl glycerol) and 1 g polyethylene‐glycol 3350. The best accepted test meal for children over 3 years old was a slice of white bread with 5 g butter and 15 g chocolate paste, mixed with 250 mg 13 C‐labeled MTG, and a glass of 100 mL whole‐fat milk. Children over 3 years old were able to blow through a straw in a vacutainer for collecting the breath samples. In children under 3 years old, expired air was collected by aspirating breath via a nasal prong. Carbon dioxide production was calculated according to weight, age, and sex.ResultsFor healthy pediatric control participants, the mean values for cumulative excretion of 13 CO 2 as a percentage of the administered dose after 6 hours were 23.9 ± 5.2% in premature infants, 31.9 ± 7.7% in full‐term infants, 32.5 ± 5.3% in children, and 28.0 ± 5.4% in teenagers. The mean value for healthy adults is 35.6% with a lower reference limit of 22.8%.ConclusionsAge‐specific test meals and breath‐sampling techniques for the MTG breath test were defined. The mean values for different age groups may serve as guidelines for normal values in the pediatric population. The cumulative values for expired 13 CO 2 were above the lower limit for adults, which suggests that preduodenal lipases compensates for pancreatic lipase deficiency in premature and full‐term infants.

Predictive Accuracy of the Wide Range Assessment of Memory and Learning in Children With Attention Deficit Hyperactivity Disorder and Reading Difficulties

The predictive accuracy of the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990) over and above more standardized diagnostic tools in children with attention deficit hyperactivity disorder (ADHD) and reading disabilities (RD) was examined. Fifty-three children with ADHD, 63 with RD, 63 with ADHD-RD, and 112 normal comparison children were administered the WRAML, the Wechsler Intelligence Scale for Children-Third Edition (WISC-III; Wechsler, 1991), the Achenbach (1991) Child Behavior Checklist (CBCL), and the Woodcock-Johnson Psycho-Educational Battery-Revised (WJ-R; Woodcock & Johnson, 1989). Results of a series of discriminant function analyses revealed that the academic, intellectual, and behavioral measures could correctly classify 73.1% of children, but the WRAML subtests alone were able to correctly classify only 58.5% of participants. Combining all of the memory, academic, intellectual, and behavioral measures resulted in 77.5% of cases being correctly classified. These results suggest that the use of a measure of memory functioning such as the WRAML did not significantly improve the predictive accuracy of a diagnosis of ADHD, RD, or both over and above more standard diagnostic academic, intellectual, and behavioral measures.

Transesophageal electrophysiological study — simple and effective diagnostic tool in children

Transesophageal electrophysiological study — simple and effective diagnostic tool in children

Transesophageal electrophysiological study — simple and effective diagnostic tool in children

Transesophageal electrophysiological study — simple and effective diagnostic tool in children

Ureterovascular Hydronephrosisin Chil dren: Is Pyeloplasty Always Necessary?

Objective: To evaluate the efficacy of the vessel transposition technique in ureterovascular hydronephrosis in children. Methods: Over a 25-year period, we treated 111 patients with 112 instances of ureterovascular hydronephrosis. In order to determine the obstructive effect of the vessels, we performed an intraoperative diuretic test. Using this approach, 61 patients judged to have only vascular pyeloureteral junction obstruction underwent vessel transposition. However, 50 patients in whom the intraoperative diuretic test proved doubtful needed pyeloplasty. Results: Surgical success was achieved in 98% of the patients. Only 1 child treated by vessel transposition had an unsatisfactory outcome which necessitated a subsequent pyeloplasty for persistent hydronephrosis. This was due to a previously unrecognized intrinsic pyeloureteral junction obstruction. Conclusion: Based on our clinical experience, the intraoperative diuretic test has proven to be a safe and effective diagnostic tool in children with ureterovascular hydronephrosis. Its use may contribute to treating some cases of ureterovascular hydronephrosis without resorting to pyeloplasty.

Effectiveness of a home-made meat based formula (the Rezza-Cardi diet) as a diagnostic tool in children with food-induced atopic dermatitis.

The aim of this study was to investigate the effectiveness of a home-made meat based formula (the Rezza-Cardi diet), as a diagnostic tool for children with atopic dermatitis and suspected multiple food hypersensitivity. Severity scores for atopic dermatitis, body weight and serum lipid profile were evaluated at baseline and four weeks following the feeding with the home-made meat based formula in 16 children with atopic dermatitis and suspected multiple food hypersensitivity. The severity score of the skin lesions improved considerably in all the children; no significant difference was observed in the serum lipid levels before and after one month following the feeding with the home-made meat based formula. All children gained weight according to the Italian Standards. The results of this study indicate that the home-made meat based formula is a useful elimination diet in children with atopic dermatitis and suspected multiple food hypersensitivity.

Open lung biopsy–successful diagnostic tool with therapeutic implication in the critically ill paediatric population

Open lung biopsy (OLB) is an important diagnostic tool in children with immune deficiency and/or chronic lung disease with diffuse pulmonary compromise. These patients require a tailored therapeutic approach owing to their fragile status and the side effects of unnecessary or inadequate treatment. Twenty‐six patients of mean age 5.6 y underwent 41 open lung biopsies in our centre between 1991 and 1995. Seventeen (65%) were immunocompromised (including 13 with malignancy) and 9 had other lung diseases. The biopsies were diagnostic in 25 patients (96%), and complete clinical‐pathological correlation was found in 11 (42%). A specific infectious aetiology was detected in nine patients (35%), all of them immunocompromised. Therapeutic changes were instituted on the basis of the biopsy findings in 18 patients (69%). Two patients had postoperative complications (prolonged pleural leak). We conclude that OLB is a safe diagnostic procedure even in the critically ill child and should be employed without hesitation when conventional methods fail to provide a definitive diagnosis to help redirect therapy.

Open lung biopsy--successful diagnostic tool with therapeutic implication in the critically ill paediatric population.

Open lung biopsy (OLB) is an important diagnostic tool in children with immune deficiency and/or chronic lung disease with diffuse pulmonary compromise. These patients require a tailored therapeutic approach owing to their fragile status and the side effects of unnecessary or inadequate treatment. Twenty-six patients of mean age 5.6 y underwent 41 open lung biopsies in our centre between 1991 and 1995. Seventeen (65%) were immunocompromised (including 13 with malignancy) and 9 had other lung diseases. The biopsies were diagnostic in 25 patients (96%), and complete clinical-pathological correlation was found in 11 (42%). A specific infectious aetiology was detected in nine patients (35%), all of them immunocompromised. Therapeutic changes were instituted on the basis of the biopsy findings in 18 patients (69%). Two patients had postoperative complications (prolonged pleural leak). We conclude that OLB is a safe diagnostic procedure even in the critically ill child and should be employed without hesitation when conventional methods fail to provide a definitive diagnosis to help redirect therapy.

Endoscopy of the upper gastrointestinal tract as a diagnostic tool for children with human immunodeficiency virus infection

The purpose of this study was to determine the prevalence of upper gastrointestinal tract lesions in children with human immunodeficiency virus (HIV) infection who undergo endoscopy of the upper gastrointestinal tract and to identify important clinical predictors of abnormal endoscopic results. All HIV-infected children who underwent endoscopy and were followed at Children's Hospital, Boston, from January 1985 to August 1994 were studied. The main outcome measure was endoscopic results, which were categorized into observational, histologic, and microbiologic findings. Potential predictors included height, weight, nutritional interventions, HIV disease stage, CD4 T-lymphocyte count, medications, active infections, and indications for endoscopy. Forty-three endoscopies in unique patients are reported. Most children had advanced HIV infection (67% acquired immunodeficiency syndrome, mean CD4 T-lymphocyte count z score = -2.71, weight z score = -2.04). An abnormal endoscopic finding was discovered in 93% of children and confirmed by histologic, microbiologic, or a combination of these studies in 72% of children. Thirty-five percent of children had an opportunistic pathogen identified endoscopically; 65% of these pathogens were previously undiagnosed. Observational findings often were poor indicators of histologic and microbiologic abnormalities. Independent predictors of abnormal histologic findings include younger age at endoscopy (odds ratio (OR) = 1.16 per year, 95% confidence interval (CI) (1.02, 1.33)) and guaiac-negative stools (OR = 16.7, 95% CI (1.92, 142.9)). Independent predictors of finding a pathogen at the time of endoscopy include a greater number of indications for endoscopy (OR = 2.6 per indication, 95% CI (1.3, 5.3)) and diagnosis of acquired immunodeficiency syndrome (OR = 16.4, 95% CI (1.3, 213)). No other gastrointestinal, nutritional, or immunologic parameters were significantly predictive of endoscopic outcomes. Medical management was changed in 70% of children because of the endoscopic findings. Endoscopy is a useful tool to direct therapy against peptic and infectious disorders of the upper gastrointestinal tract in children with HIV infection. Specific gastrointestinal symptoms are not useful predictors of abnormal results.

Laparoscopic surgery in pediatric urology.

In pediatric urology laparoscopy is more and more used for diagnostic and therapeutic indications. From January 1992 to August 1995, we performed 86 laparoscopic procedures in pediatric patients. In 23 patients with cryptorchidism laparoscopy was used for diagnostic and/or therapeutic reasons. Laparoscopic repair of varicocele (n = 37) and hydrocele (n = 4) was performed. Vesicoureteral implantation was done in 6 patients and nephroureterectomy/heminephroureterectomy in 3 and 9 patients. In 2 patients vesical diverticulum were excised laparoscopically and in intersex laparoscopy was used in 2 patients. Laparoscopy is the most reliable diagnostic tool in children with cryptorchidism and allows, if necessary, therapy in the same procedure, such as orchiectomy or dissection of the testicular vessels in preparation for a Fowler-Stephens procedure. For varicocele repair the laparoscopic approach offers a simple and effective method with a low recurrence rate. More technically demanding and performed only in specialized centers are laparoscopic nephrectomy or heminephroureterectomy. These latter procedures have shown to be superior to the open surgical approach regarding morbidity, complication rate and hospital stay.

Indications for echocardiography in the diagnosis of infective endocarditis in children

The role of transthoracic echocardiography as a diagnostic tool in children suspected of having infective endocarditis (IE) has not been defined. We hypothesized that echocardiography is only useful in children in whom there is high clinical suspicion of IE based on physical examination findings or persistently positive blood cultures. Echocardiographic reports and medical records of all inpatients (n = 133) from 1990 to 1992 who underwent echocardiography for suspected IE were reviewed. Fifty-nine of the 133 patients (44%) identified had either persistently positive blood cultures (n = 48), physical examination findings of IE (n = 20), or both (n = 9). The echocardiogram was positive in 7 of these patients (12%) and negative in all 74 patients without positive physical findings or positive blood cultures (p = 0.003). A new or changing precordial murmur, embolic phenomena, congestive heart failure, mechanical ventilation, and positive blood cultures were predictive of positive echocardiograms for IE by univariate analysis. The presence of fever, immune deficiency, and central lines, alone or in combination, was not predictive of a positive echocardiogram. In the absence of physical findings or persistently positive blood cultures, echocardiography is a low-yield study and is unlikely to aid in the diagnosis of IE in children.

The Utility of Electroencephalography and Cerebral Computed Tomography in Children with Mild and Moderately Severe Closed Head Injuries*

The utility of electroencephalography and computed tomography has been studied in a prospective follow-up study of 54 children with mild and moderately severe closed head injuries. EEG and CT scan were recorded in the acute phase. Furthermore the duration of coma and of post-traumatic amnesia were registrated. During a two years follow up period the presence of residual disorders in various faculties was evaluated at fixed time intervals after discharge. The data have been subjected to correlation analyses to study the relation of EEG and CT scan findings with the severity of the trauma and with the occurrence of longterm sequelae. Both the EEG and the CT scan abnormalities are found to correlate appreciably with the degree of severity and with the occurrence of, in particular, long-term sequelae in the fields of neurological disturbances and school performance. It is concluded that EEG and CT are useful diagnostic tools in children with mild and moderately severe closed head injuries.

Pediatric electrocardiography in the emergency department.

Electrocardiography can be a useful screening and diagnostic tool for children seen in an Emergency Department setting. This article reviews the technical aspects of electrocardiography in children and offers an approach to interpretation. Normal values for ECGs in children are presented in tabular format. Electrocardiographic features of several specific conditions are discussed.

Histologic grading of reflux oesophagitis and its relationship with intra-oesophageal and intragastric pH variables

Objective To determine the relationship between histologic grading of reflux oesophagitis and both intra-oesophageal acid exposure and intragastric acidity. Methods Endoscopy and simultaneous 24-h recording of intra-oesophageal and intragastric pH. Patients Eighty-one patients with symptoms strongly suggesting gastro-oesophageal reflux disease; intra-oesophageal and intragastric pH was also recorded in 16 controls. Results: Reflux oesophagitis was found in 71 patients and was graded as follows: mild-A (15 patients), mild-B (26 patients), moderate (16 patients) and severe (14 patients). Abnormal gastro-oesophageal reflux was found in the remaining 10 patients, although there was no histological evidence of reflux oesophagitis. There was no statistical difference in the oesophageal acid exposure or in the number of gastro-oesophageal reflux episodes lasting ≥5 min when the reflux oesophagitis groups were compared. Intragastric acidity, median intragastric pH and percentage of intragastric pH <2 were significantly higher in patients with severe reflux oesophagitis compared with the other reflux oesophagitis groups. Conclusions Endoscopy and histology of the oesophagus seem to be the most valuable diagnostic tools in children with symptoms suggesting gastro-oesophageal reflux disease. Furthermore, the severity of oesophagitis appears to be related more to the potency of refluxed material than to oesophageal acid exposure.

Experience with flexible fiberoptic bronchoscopy with bronchoalveolar lavage as a diagnostic tool in children with AIDS.

To report our experience with flexible fiberoptic bronchoscopy with bronchoalveolar lavage in children with the acquired immunodeficiency syndrome and acute lower respiratory tract disease. Retrospective study. Children's Medical Center of Brooklyn, NY, a tertiary-level inner-city hospital. Eighty-five children with acquired immunodeficiency syndrome and acute lower respiratory tract disease. One hundred five flexible fiberoptic bronchoscopies with bronchoalveolar lavages. Infective agents were recovered in 88 procedures (84%). Potentially pathogenic bacteria were identified in 56 (56.6%) of 99 procedures. Viruses were found in 28 (29%) of 96 lavages, and fungi in 37 (41.6%) of 89 specimens. Pneumocystis carinii was identified in 22 (22.2%) of 99 specimens. Mycobacteria were isolated from 14 (14%) of 100 specimens. A serious complication occurred in only one procedure (0.95%). Flexible fiberoptic bronchoscopy with bronchoalveolar lavage is a safe and effective diagnostic procedure that identified infective agents in 80% of children with acquired immunodeficiency syndrome and concomitant acute lower respiratory tract disease.

Serum Growth Hormone Levels Measured by Radioimmunoassay and Radioreceptor Assay: A Useful Diagnostic Tool in Children with Growth Disorders?*

Serum GH levels were measured by RIA and RRA in 133 subjects (19 healthy controls and 114 patients with various growth disturbances, aged 2.3-24.8 yr). Serum samples obtained from 147 stimulation tests representing a total of 1065 samples were analyzed by both methods, and the results compared. The data are expressed in absolute values and in RRA/RIA ratios. The area under the curve after a stimulation test (area GH) was calculated by planimetry. RIA was performed by the classical double antibody method using a polyclonal anti-serum. For the RRA, human cultured lymphocytes (IM-9 cells) were used, and 125I-labeled human GH was purified by high performance liquid chromatography. The same human GH standard was used in both assay systems. In control subjects a significant (P less than 0.0001) positive correlation was found at all ages between GH levels measured by RIA and RRA (r = 0.69 after insulin and r = 0.77 after glucagon). The RRA/RIA ratio (mean +/- SEM) for the peak GH level was 0.88 +/- 0.05, and the area under the GH curve was 0.85 +/- 0.05. The peak mean RRA/RIA ratios were significantly lower (P less than 0.05 and P = 0.03, respectively). No relationship was found with the absolute value of either peak or area GH. In patients with growth delay and Turner's syndrome, lower GH levels were found than in control subjects in both assay systems. The RRA/RIA ratios were also lower. In the other patients with some growth disorder, normal GH levels and ratios were found. In patients with renal failure, high levels of RIA-GH and RRA-GH were found, with a normal RRA/RIA ratio. In patients with documented pituitary GH deficiency, GH-releasing factor administration resulted in an increase in GH levels that was identical in both assays. The RRA/RIA ratio remained constant throughout the test. No correlation was found between the ratio and the absolute value of either RIA-GH or RRA-GH regardless of the stimulation test used. It is concluded that the presence of an abnormal GH molecule is extremely rare in patients with short stature. Thus, the presence of a bioinactive hormone is not a common cause of growth failure. During provocative testing some changes in the ratio may occur that do not appear after GH-releasing factor, further illustrating the different mechanisms involved in GH secretion.

A new glass microfibre‐based histamine analysis for allergy testing in children

A new microfibre method for allergy testing measuring histamine release from human basophil leukocytes is described. Samples of 50 microliter washed blood are challenged with the suspected allergens. Released histamine is bound to microfibres and measured by a spectrofluorometrical method after removal of interfering substances by washing. The microfibre method (HR-MM) was compared to the conventional histamine release assay using the Ficoll-Hypaque gradient method (HR-FH) in 19 allergic children tested with one of three allergens. In addition, a comparison was made between the microfibre method and in vivo provocation tests, i.e. skin prick test (SPT), bronchial provocation test (BPT) and allergen specific serum IgE (RAST). It was found that the same individuals responded with histamine release to the same allergens in both histamine release assays, and the dose-response curves were almost identical. A positive correlation was found between the in vivo and in vitro tests. Thus it is concluded that the new method can provide reproducible, analytically precise (at the nanogram level) histamine release results in pediatric cases where: a positive SPT does not correlate with case history; BPT may be considered too hazardous or inconvenient; confirmation of negative or inconclusive SPT or RAST is needed. In contrast to other histamine release assays it is a convenient diagnostic tool in children since only small amounts of blood are needed and at least 96 tests can be carried out in 2 1/2 h.

Arthrography of the ankle joint in injuries of the fibular ligament system in children and adolescents

Arthrography of the ankle is an optimal diagnostic tool in children and adolescents facilitating differential diagnosis between a simple ankle sprain and rupture of the fibular ligaments. It can moreover help to differentiate between rupture of a single and of two ligaments. 35 young patients with surgically confirmed ligamentous rupture were evaluated according to conventional radiographic criteria, and part of them by arthrography. The technique of the latter and the quite frequent normal variants in arthrograms of the ankle in childhood are described. The comparison of the pathologic anatomy disclosed by surgery and the arthrogram reveals a very good correlation. Its main value resides in giving fair information in clinically and radiographically controversial cases.

The use of luteinizing hormone-releasing hormone in pediatric patients.

Luteinizing hormone-releasing hormone (LH-RH), first synthetized in 1971; became soon available for clinical purposes and was immediately used as a diagnostic tool in children and adolescents as well as in adults. The first results of the LH-RH test in pediatrics were reported in 1972 and soon after discussed in meetings allowing comparison of the data from different groups. From this time, a great number of publications has been devoted to the diagnostic usefulness of LH-RH in the study of pubertal development and of pituitary-gonadal disorders in children and adolescents. Until recently, the theraeputic use of LH-RH has been restricted by the lack of availability of sufficient amounts, so that only few preliminary data have been reported in this field. Thus the scope of this review is mainly to present a critical survey of the data concerning LH-RH test in pediatric patients.