We investigated potential diagnostic usefulness of serum and cerebrospinal fluid (CSF) concentrations of chemokines CXCL10, CXCL11, and CXCL13 in pediatric patients with acute disseminated encephalomyelitis (ADEM) (n = 23), non-polio enterovirus aseptic meningitis (NPEV AM) (n = 20), and neuroborreliosis (NB) (n = 21) and children with acute infectious diseases with neurological symptoms but with excluded neuroinfection/neuroinflammation (controls, n = 20). CSF levels of CXCL10 and CXCL11 were higher in patients with NPEV AM than those in other children, and CXCL10 levels showed a high discriminative potential (area under the receiver operating characteristic curve, ROC, 0.982) with high specificity and sensitivity (both 95%). CSF levels of CXCL13 were higher in NB patients than those in other children; however, discriminative potential (area under ROC curve 0.814) and diagnostic properties were moderate (sensitivity 67%, specificity 97%). Data suggest usefulness of chemokine quantification as a diagnostic aid in children with suspected ADEM, NPEV AM, or NB.
Objective -To determine the success rate of the newly introduced method of ultrasound guided hydrostatic reduction in detected ileocolic intussusception by retrospective analysis. Materials and methods -Analysis was performed on all diagnosed ileocolic intussusceptions during the period of December 2013 to November 2015 at the Department for pediatric Radiology of the Children's Hospital Zagreb. In this period of time 34 patients were diagnosed with ileocolic intussusception. Ultrasound guided hydrostatic reduction was performed in 31 patients. We performed ultrasound guided hydrostatic reposition using saline solution warmed at body temperature. Saline was applied per rectum. When the intussusceptum crossed the ileocecal valve, the reposition was considered successful. Results -Out of 34 patients, three patients were treated with an urgent surgical procedure, while ultrasound guided hydrostatic reduction was performed in 31 patients. The non-surgical procedures were successful in all cases and complete reductions of intussusception were achieved in all 31 patients. In three patients, reinvagination occurred within the first 48 hours. Conclusion -Ultrasound guided hydrostatic reduction of ileocolic intussusceptions in children is a very simple and effective technique. The success rate was 91.2% (31/34). The recurrence rate was 8.8%.
Inflammatory bowel disease (IBD) is a well-recognized risk factor for thrombotic events in adults but data on children are scarce. In the great majority of adult patients, thrombotic events are usually deep vein thrombosis and pulmonary embolism. Other sites such as jugular veins are extremely rare. We present a case of Lemierre syndrome in an adolescent girl with active ulcerative colitis and discuss possible risk factors. This is the first reported case of severe Lemierre syndrome with thrombus extension to cranial veins in a patient with ulcerative colitis. Early recognition of Lemierre syndrome in patients who present with rapidly worsening symptoms of neck pain, fever and signs of pharyngitis is imperative because it increases a chance of favorable prognosis. It is important for pediatricians treating IBD patients not to underestimate possible thrombotic events in children with IBD. Recognition of additional risk factors is crucial for prompt diagnosis and adequate treatment.
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