Sergey Keidar, MD, Liat Ben-Sira, MD, Mark Weinberg, MD, Ariel J. Jaffa, MD, Aviel Silbiger, MD and Itzhak Vinograd, MD
Background: Routine prenatal ultrasound has increased the frequency of prenatal diagnosis of congenital cystic lung malformation, such as cystic adenomatoid malformation, pulmonary sequestration, congenital lobar emphysema, and bronchogenic cyst.
Objectives: To evaluate the methods of postnatal diagnosis, the optimal age for operation since surgery is always required, and the optimal extent of lung resection.
Methods: The clinical courses of 11 patients with congenital lung cysts who underwent surgical lung resection (8 lobectomies and 3 segmentectomies) were reviewed.
Results: The diagnosis was confirmed by computed tomography scan in all. In nine patients the diagnosis was made prenatally. Chest X-ray was normal postnatally in all patients except for two who had recurrent pneumonia. Postoperative follow-up showed excellent recovery in all operated children. One patient who underwent surgery for CCAM following episodes of severe pneumonia died from another cause 5 months later. Postoperative chest CT scan showed no residual disease in eight patients. In two who had undergone limited resection, tomography showed a small segment of residual disease in one and a suspected residual lesion in the other.
Conclusion: With prenatal ultrasound the true frequency of congenital cystic lung anomaly appears to be higher than previously reported. Postnatal CT is mandatory to confirm or to rule out the diagnosis. The mere presence of cystic lung malformation is an indication for surgery. Complete removal of the affected lung lobe is recommended. Segmental resection may be inadequate. Early operation is tolerated well by infants and small children and we recommend that surgery be performed in children between 6 and 12 months of age.
Ofer N. Gorfit, MD and Khalil Abu-Dalu, MD
Background: Despite years of research and clinical experience with acute appendicitis, the rate of complications in the pediatric age group continues to be high.
Objective: To characterize the profile of the child with appendicitis complicared by perforation or intraabdominal abscess.
Methods: Between 1 January 1985 and 31 December 1997 in our department, 581 children under the age of 14 years were clinically diagnosed as suffering from "acute appendicitis". The final diagnoses were: white appendix in 28 cases (4.8%), acute non-complicated appendicitis in 472 (81%), and complicated appendicitis in 81 (13.9%), including 51 cases of free perforation (8.7%) and 30 cases of intraabdominal abscess (5.2%). We retrospectively reviewed the charts of all children with complicated appendicitis and those of 70 randomly selected children with non-complicated appendicitis, and compared patient age, gender, weight percentile, past medical history, and course of the illness.
Results: The children with complicated appendicitis were significantly younger (R~4.8*10~7), they had higher oral and rectal temperatures (P=7.9*10-8), higher platelet count (P=0.0008) and lower hemoglobin level (P=0.004). No difference was found in white blood count (P=0.41). Total delay from symptom onset to surgery was 33 hours (SD 23) in the non-complicated group, 60 hours (SD 38) in the perforated appendicitis group, and 176 hours (SD 107) in the intraabdominal abscess group (P=4.6*10-8). No difference in intrahospital delay was found.
Conclusions: Children with complicated appendicitis are characterized by younger age, longer delay from symptom onset to correct diagnosis, and typical laboratory findings. Delays in diagnosis can be avoided by first considering the diagnosis of acute appendicitis in the differential diagnosis when examining any child with abdominal pain.
Haim Shmuey, MD and Yaron Niv, MD
Dror Kraus Bmed, Sc, Igor Kaiserman, MD, Joseph Frucht-Pery, MD and Rami Rahamimoff, MD
Allan Wilk
Anti-neutrophil cytoplasm antibodies are important markers of certain small vessel necrotizing vasculitides, but the optimal use of laboratory results in daily clinical practice necessitates collaboration between clinicians and laboratory specialists. Physicians must familiarize themselves with ANCA tests in ANCA-related vasculitides as well as in differential diagnostic patient populations in order to define cutoff values. Indirect immunofluorescence with a consensus-agreed technique combined with standardized enzyme immunoassays is the modality for detecting the main SSV-associated ANCA specificities using cutoff values that can sufficiently distinguish SVV from non-SVV patients. The combined use of IF and direct EIA to demonstrate proteinase 3-ANCA and myeloperoxidase-ANCA at significant levels leads to a very high diagnostic specificity towards SVV conditions such as Wegener’s granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome, and limited forms of these such as renal-limited focal necrotizing glomerulonephritis. A strong reactivity of ANCA against several azurophil granule components indicates a drug-induced syndrome. ANCA-related SVV and druginduced vasculitis or lupus syndromes have characteristic ANCA profiles that can help distinguish these conditions from other inflammatory diseases.
Arnon Blum, MD, Yami Shapira, MD, Shay Yeganh, MD and Maya Rabinkov, MD
Jamal Awad, MD and Ofer Schiller, MD
Yoav Turgeman, MD, Shaul Atar, MD and Tiberio Rosenfeld, MD
Nimrod A. Kimchi, MD, Gourion Rivkin, MD, Yaron Wiener, MD, Judith Sandbank, MD and Ariel Halevy, MD
Saher F. Srour, MD and Joel Sayfan, MD
Gady S. Cojacaru, Gideon Rechavi, MD, PhD and Naftali Kaminski, MD
Haim Berkenstadt, MD and Zvi Ram, MD
Hana Strul, MD, Michal Carmiel, MD and Fred Konikoff, MD