PURPOSE: Acute septic arthritis in infancy and childhood is uncommon. Delay of diagnosis and inappropriate treatment of septic arthritis results in permanent physical sequelae. We studied the initial treatment, clinical manifestations, involved sites, and etiologic organisms of septic arthritis. METHODS: We reviewed 74 patients who were diagnosed septic arthritis in Departments of Pediatrics and Orthopedic Surgery, Yonsei University College of Medicine from July 1986 to Sep. 1995. RESULTS: 1) Seventy-four children in the treatment group comprised of 48 males and 26 females. The age distribution is : 21 cases of neonates (28%), 19 cases of infants (26%), and 34 cases of children under 15 years. 2) The frequently involved sites were : 34 cases of hip joint (45%), 28 cases of knee joint (37%), 8 cases of shoulder joint (10%), 4 cases of elbow joint (5%), and 2 cases of ankle joint (3%). In two cases, two joints were involved simultaneously. 3) On imaging studies, 37.8% (28/74) of all cases had abnormal X-ray findings initially. Bone scan were done in 43 cases (58.1%). Half of these cases (22/43) had abnormal, increased uptake in involved joint during the third hospital day through seventh. 4) There were some predisposing factors. : respiratory tract infection (63.5%), trauma (6.8%), sepsis (8.1%), congenital hip dislocation (1/74). However, there were no specific problems in 15 cases. 5) Major complaints of patients were : limitation of motion, fever, local swelling, pain, tenderness, erythema, irritability, and heating sensation, etc. 6) Sixty-three cases had bacterial growth, either from blood or wound. Wounds cultures were positive in 23 cases. : S. aureus (13/23), Streptococcus (6/23). The combination of incision & drainage, irrigation, intravenous antibiotics and traction were therapeutic modalities. Antibiotics used were cephalosporins and vancomycin. CONCLUSIONS: Early diagnosis and treatment are essential to prevent the permanent sequelae of septic arthritis. In cases presenting with limitation of motion, fever, or pain with or without abnormal radiologic findings, septic arthritis should be ruled out.
Age Distribution ; Ankle Joint ; Anti-Bacterial Agents ; Arthritis, Infectious* ; Causality ; Cephalosporins ; Child* ; Diagnosis ; Drainage ; Early Diagnosis ; Elbow Joint ; Erythema ; Female ; Fever ; Heating ; Hip Dislocation, Congenital ; Hip Joint ; Hot Temperature ; Humans ; Infant ; Infant, Newborn ; Joints ; Knee Joint ; Male ; Orthopedics ; Pediatrics ; Respiratory Tract Infections ; Sensation ; Sepsis ; Shoulder Joint ; Streptococcus ; Traction ; Vancomycin ; Wounds and Injuries

PURPOSE: Acute septic arthritis in infancy and childhood is uncommon. Delay of diagnosis and inappropriate treatment of septic arthritis results in permanent physical sequelae. We studied the initial treatment, clinical manifestations, involved sites, and etiologic organisms of septic arthritis. METHODS: We reviewed 74 patients who were diagnosed septic arthritis in Departments of Pediatrics and Orthopedic Surgery, Yonsei University College of Medicine from July 1986 to Sep. 1995. RESULTS: 1) Seventy-four children in the treatment group comprised of 48 males and 26 females. The age distribution is : 21 cases of neonates (28%), 19 cases of infants (26%), and 34 cases of children under 15 years. 2) The frequently involved sites were : 34 cases of hip joint (45%), 28 cases of knee joint (37%), 8 cases of shoulder joint (10%), 4 cases of elbow joint (5%), and 2 cases of ankle joint (3%). In two cases, two joints were involved simultaneously. 3) On imaging studies, 37.8% (28/74) of all cases had abnormal X-ray findings initially. Bone scan were done in 43 cases (58.1%). Half of these cases (22/43) had abnormal, increased uptake in involved joint during the third hospital day through seventh. 4) There were some predisposing factors. : respiratory tract infection (63.5%), trauma (6.8%), sepsis (8.1%), congenital hip dislocation (1/74). However, there were no specific problems in 15 cases. 5) Major complaints of patients were : limitation of motion, fever, local swelling, pain, tenderness, erythema, irritability, and heating sensation, etc. 6) Sixty-three cases had bacterial growth, either from blood or wound. Wounds cultures were positive in 23 cases. : S. aureus (13/23), Streptococcus (6/23). The combination of incision & drainage, irrigation, intravenous antibiotics and traction were therapeutic modalities. Antibiotics used were cephalosporins and vancomycin. CONCLUSIONS: Early diagnosis and treatment are essential to prevent the permanent sequelae of septic arthritis. In cases presenting with limitation of motion, fever, or pain with or without abnormal radiologic findings, septic arthritis should be ruled out.
Age Distribution ; Ankle Joint ; Anti-Bacterial Agents ; Arthritis, Infectious* ; Causality ; Cephalosporins ; Child* ; Diagnosis ; Drainage ; Early Diagnosis ; Elbow Joint ; Erythema ; Female ; Fever ; Heating ; Hip Dislocation, Congenital ; Hip Joint ; Hot Temperature ; Humans ; Infant ; Infant, Newborn ; Joints ; Knee Joint ; Male ; Orthopedics ; Pediatrics ; Respiratory Tract Infections ; Sensation ; Sepsis ; Shoulder Joint ; Streptococcus ; Traction ; Vancomycin ; Wounds and Injuries

OBJECTIVE: To evaluate the impact of the adaptive iterative dose reduction (AIDR) three-dimensional (3D) algorithm in CT on noise reduction and the image quality compared to the filtered back projection (FBP) algorithm and to compare the effectiveness of AIDR 3D on noise reduction according to the body habitus using phantoms with different sizes. MATERIALS AND METHODS: Three different-sized phantoms with diameters of 24 cm, 30 cm, and 40 cm were built up using the American College of Radiology CT accreditation phantom and layers of pork belly fat. Each phantom was scanned eight times using different mAs. Images were reconstructed using the FBP and three different strengths of the AIDR 3D. The image noise, the contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) of the phantom were assessed. Two radiologists assessed the image quality of the 4 image sets in consensus. The effectiveness of AIDR 3D on noise reduction compared with FBP were also compared according to the phantom sizes. RESULTS: Adaptive iterative dose reduction 3D significantly reduced the image noise compared with FBP and enhanced the SNR and CNR (p < 0.05) with improved image quality (p < 0.05). When a stronger reconstruction algorithm was used, greater increase of SNR and CNR as well as noise reduction was achieved (p < 0.05). The noise reduction effect of AIDR 3D was significantly greater in the 40-cm phantom than in the 24-cm or 30-cm phantoms (p < 0.05). CONCLUSION: The AIDR 3D algorithm is effective to reduce the image noise as well as to improve the image-quality parameters compared by FBP algorithm, and its effectiveness may increase as the phantom size increases.
*Algorithms ; Animals ; Body Size ; Image Processing, Computer-Assisted/*methods ; *Phantoms, Imaging/standards ; Radiation Dosage ; Signal-To-Noise Ratio ; Subcutaneous Fat, Abdominal/*radiography ; Swine ; Tomography, X-Ray Computed/*methods