RESUMEN
We performed a retrospective review of 34 humerus shaft fractures (HSFs) in children younger than 3 years to determine the frequency of child abuse in young children with this injury. Data were obtained from hospital records (including previous and subsequent emergency, clinic, and inpatient notes), radiographs, and county childprotective services. Cases were reviewed independently by four physicians and were classified as probable abuse, probable not abuse, and indeterminate. Only 18% were classified as probable abuse. The history and findings other than the fracture itself were critical in establishing cause. Neither age nor fracture pattern is pathognomonic of abuse, but suspicion should remain high. A detailed history, complete physical examination, and appropriate radiographic investigation are required in every case either to make the diagnosis of abuse or to avoid the trauma of a false accusation.
Asunto(s)
Accidentes , Maltrato a los Niños/diagnóstico , Fracturas del Húmero/diagnóstico , Fracturas del Húmero/etiología , Fenómenos Biomecánicos , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Fracturas del Húmero/clasificación , Incidencia , Lactante , Masculino , Anamnesis , Examen Físico , Estudios RetrospectivosRESUMEN
We describe seven infants who developed renal calcification and bone demineralization following furosemide therapy with average daily doses of as little as 0.75 mg/kg per day. Renal calcifications were present in all seven cases and were more readily detected with ultrasonography than with plain films. Renal calculi were seen in four patients, sonographically demonstrated as echogenic foci in the dependent portion of the collecting system, usually accompanied by acoustic shadowing. One patient developed nephrocalcinosis, sonographically observed as echogenic medullary pyramids plus punctate, shadowing parenchymal calcifications. In two patients the location of the calcification could not be determined.
Asunto(s)
Calcinosis/diagnóstico , Furosemida/efectos adversos , Enfermedades del Prematuro/diagnóstico , Enfermedades Renales/diagnóstico , Ultrasonografía , Enfermedades Óseas/inducido químicamente , Enfermedades Óseas/diagnóstico , Huesos/análisis , Enfermedad Crónica , Humanos , Lactante , Recién Nacido de Bajo Peso , Recién Nacido , Cálculos Renales/inducido químicamente , Cálculos Renales/diagnóstico , Enfermedades Pulmonares/tratamiento farmacológico , Minerales/análisis , Nefrocalcinosis/inducido químicamente , Nefrocalcinosis/diagnóstico , Fracturas de las Costillas/diagnóstico , Factores de TiempoRESUMEN
Six cases are presented in which the sonographic appearance of adrenal enlargement in the fetus or neonate mimics that of renal tissue. When normal renal tissue is not present, the adrenal preserves its characteristic echogenic medulla and anechoic cortex but enlarges, loses its characteristic "V" or "Y" shape, and appears more elliptical on ultrasound scans. The average length of the adrenal was 3.4 cm on the right and 2.9 cm on the left in these cases, with adrenal thickness increased to an average of 5 mm. Care must be taken not to mistake the enlarged adrenal for renal tissue. Conversely, an elongated adrenal gland without adjacent renal tissue does not necessarily imply renal agenesis, but may occur with renal ectopia.