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Background: Congenital bilateral absence of the vas deferens (CBAVD) is presumed to occur prenatally and is present in over 99% of adult males with cystic fibrosis (CF). Aims: To describe ultrasonic features in male children with CF. We aimed to describe urogenital anomalies, comparing pancreatic sufficient and insufficient CF patients. Methods: Pelvic and scrotal ultrasonography were performed in 12 boys with CF aged 2–12 years and 16 age matched healthy controls. Results: Nine patients had pancreatic insufficiency (PI): seven had two severe mutations and two had unknown mutations. Three boys were pancreatic sufficient (PS), two with splicing mutations (5T and 3849+10kb C–T respectively) and borderline sweat tests. Seminal vesicles were visualised in 5/12 patients and 8/16 controls, compared to non-visualisation reported in all adults with CBAVD. Testicular microlithiasis was found in 4/18 PI, 0/6 PS, and 0/32 control testes, compared to 0.6–1.4% in healthy males and 15% in CF adults; 7/18 PI, 4/6 PS, and 0/32 control testes were smaller than predicted for age. The epididymal head was non-homogeneous with cysts, hypo-, or hyper-echogenicity in 5/18 PI, 1/6 PS, and 0/32 control testes. Conclusions: Genital abnormalities may occur early in CF, but are less common than described in adults. They are found more often in pancreatic insufficient than in pancreatic sufficient CF patients. However, a positive finding, if present, may aid in the diagnosis of the latter. A larger longitudinal study is recommended to better define the onset and progression of urogenital abnormalities.

Background. The extent of involvement of the subcutaneous Tenckhoff catheter tract in CAPD peritonitis and catheter-related infections is of major therapeutic importance. By definition. both peritonitis and exit-site infections do not involve the catheter tract. However, diagnosis of these infections as well as the more sinister tunnel infection is based mainly on clinical signs. Methods. We examined the usefulness of ultrasound examination (US) of the catheter tract in delineating catheter-related (exit-site and tunnel) infections, and their relationship to each other and to peritonitis. CAPD patients with no evidence of peritonitis or catheter-related infections for 6 months prior to examination served as controls. US were performed by one of two experienced radiologists using the Acuson 128XP/10 scanner with a 7-MHz linear transducer. A positive US was defined as an area of hypoechogenicity (indicative of fluid collection) >2 mm in width along any portion of the catheter tract. Findings were localized into segments (S) as follows : S1, limited to external cuff ; S2, intercuff segment adjacent to the external cuff : S3, intercuff segment adjacent to the internal cuff ; S4, limited to the internal cuff ; and S5, involvement extending throughout the catheter tract. Results. Between March 1993 and January 1995, 39 CAPD patients, all with a double-cuff straight Tenckhoff catheter with the exit site situated above the point of entry into the peritoneum were studied. A total of 56 US were performed divided among 26 episodes of peritonitis, four tunnel infections, 13 exit-site infections, and 13 controls. There were 30 positive US distributed among 16 peritonitis, four tunnel, eight exit site infections and two control patients. The two positive controls went on to develop peritonitis within 1 month of the US. The majority of the US findings (13/16 in episodes of peritonitis and 5/8 exit site infections) were localized to segment 4, that is, to the internal cuff region. Apart from a significant increase in width in all infected segments versus a normal tunnel, no differences in size were seen between peritonitis, exit-site, or tunnel infections, nor were there any differences in size and localization in these infections when comparing the offending organism (Gram-positive, negative, or culture negative). Conclusions. We conclude that peritonitis and exit-site infections are frequently accompanied by involvement of the catheter tract. The localization of infection to the internal cuff region in cases of exit-site infection probably occurred as a result of downward migration along the catheter tract. This supports the notion that ideally the exit site should be pointing caudally or that the peritoneal catheter have a swan-neck configuration. With regard to peritonitis, infection within the peritoneal cavity appears to extend and involve the internal cuff region. Thus both the internal and external cuffs do not seem to pose an effective barrier against the spread of infection. Based on our data, we recommend that US be performed as a routine investigation in all cases of exit-site infection and in cases of refractory or relapsing peritonitis.

Objective To determine the effects of the changes in fetal renal pelvis dilatation on post-natal diagnosis and outcome. Methods Prenatal sonographic fetal renal anteroposterior diameters of ≥4 mm in the second trimester, which persisted to ≥7 mm in the third trimester, were the inclusion criteria. Fifty-six fetuses and 73 renal units with normal karotypes and a solitary sonographic finding of renal pyelectasis, which met the inclusion criteria, were followed, post-natally, until the age of 30 months. The neonates were categorized into three groups, according to their final diagnosis: No hydronephrosis, pelvi-ureteric junction obstruction and hydronephrosis from other causes. The neonates were also categorized according to their outcome: no treatment, follow-up only and surgical treatment. Results In 17 neonates (30.4%), and 19 renal units, the diagnosis of hydronephrosis was excluded post-natally. In 39 neonates (69.6%), and 54 renal units, an urinary tract pathology was confirmed. The dynamics of pyelectasis in the second and third trimesters of pregnancy differed significantly among the neonates when categorized according to the final diagnosis (P < 0.05), or according to outcome (P < 0.05). Conclusion It is possible to predict, and distinguish between, long-term conservative and surgical treatments of renal pelvis dilatation in the third trimester of pregnancy. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

The aim of the study was to investigate the place of imaging in the diagnosis and treatment of acute appendicitis. The files of 2,427 children with suspected acute appendicitis were reviewed for clinical management and operative findings. The sample was divided into 3 groups at time of admission: (1) before diagnostic imaging was available in our department (1991-1994); (2) after the introduction of imaging studies on a random basis in equivocal cases (1995-1998); and (3) after a policy was formulated for ultrasound use in all equivocal cases followed by computed tomography if necessary (1999-2000). Results showed that the rate of misdiagnosis decreased from 13.2% in group 1 to 6.5% in group 2 and 6.1% in group 3. False-positive findings (normal appendix with positive scan) were noted in 16.7% of group 2 and 25% of group 3; false-negative findings (appendicitis at surgery with negative scan) in 23.8% and 9.5%, respectively. Computed tomography was performed in 8 children and prevented unnecessary surgery in 4 of them. We conclude that in equivocal cases of acute appendicitis, imaging studies performed by skilled operators can improve the accuracy of diagnosis, saving patients unnecessary surgery, and identifying other conditions that mimic appendicitis.

Eighty patients with benign prostatic hyperplasia underwent transperineal ultrasonographic evaluation of prostatic size and calculation of prostatic volume. In 10 patients transabdominal prostatic ultrasonography was also performed and the findings compared with those of transperineal examination. The estimated prostatic volume measured by transperineal ultrasonography was compared to the actual weight of the surgically removed gland. The correlation coefficient was 0.89 (P less than 0.0001). The transperineal and transabdominal ultrasonographic estimated volumes were also compared. The correlation coefficient was 0.92 (P less than 0.0001). No pain or discomfort were reported by the patients. Transperineal ultrasonography appears to be an accurate, fast and easy method to evaluate prostatic volume.

A 14-year-old boy presented with anorexia and weakness whereon the diagnosis of dimorphic anaemia was made. An excellent response to iron and vitamin B12 was observed. In addition, the patient had non-obstructive hypertrophic cardiomyopathy. At endoscopy 2.5 years later, an adenocarcinoma was diagnosed and the patient underwent a high subtotal gastrectomy. To the best of our knowledge, this rare association has never been reported in children.We report a youngster with pernicious anaemia, associated with nonobstructive hypertrophic cardiomyopathy in whom gastric adenocarcinoma was found. Patients with pernicious anaemia are at greater risk of developing gastric carcinoma than the general population, therefore we recommend routine periodic gastroscopic surveillance in the paediatric population with pernicious anaemia.

Hamartomas of the spleen are rare benign tumours, which are usually asymptomatic, incidental findings at laparotomy or autopsy (Komakl and Gombas, 1976; Brinkley and Lee, 1981; Norowitz and Morehouse, 1989). There are a few well documented reports of symptomatic splenic hamartoma associated with haematological disturbances, marked splenomegaly or even spontaneous rupture that required an emergency operation (Iozzo et al., 1980; Morgenstern et al., 1984). We report a patient with splenic hamartoma who presented with splenomegaly and iron deficiency anaemia. Computed tomographic (CT) and ultrasound (US) evaluation demonstrated an inhomogeneous mass within the enlarged spleen. Malignant melanoma was mistakenly diagnosed by US-guided fine needle aspiration of the mass, and necessitated splenectomy. The final diagnosis was hamartoma of the spleen.