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Biomedical subjects

A Daneman

Publications and source records attributed to A Daneman.

At least 55 records · Page 3Linked to original sources
PubMed1997

Abdominal calcification in cystic fibrosis with meconium ileus: radiologic-pathologic correlation.

BACKGROUND: There is confusion in the radiological literature as to the site of abdominal calcification in cystic fibrosis (CF) with meconium ileus (MI) in neonates. PURPOSE: To correlate the site of radiographic abdominal calcification with histologic and operative findings. MATERIALS AND METHODS: A review of clinical, radiographic, surgical and histologic data in 58 neonates with CF and MI. RESULTS: Abdominal calcification was identified in 15 (26 %) neonates: on an abdominal radiograph in 8 (13 %), at laparotomy in 3 and histologically in 10 (37 %) of the 27 resected specimens. The radiographic pattern of calcification varied from small specks in three cases to small, better-defined areas in two. In the other three patients, the calcification was more extensive and curvilinear. Histologically, calcification was found to be intramural in ten resected specimens, of which two also had intraluminal and one serosal calcification. The more extensive, curvilinear calcification identified radiographically correlated with histologically proven dystrophic intramural calcification. The less marked flecks or discrete areas of radiographic calcification may represent intramural, serosal or intraluminal calcification. CONCLUSION: Intramural calcification is common microscopically in CF with MI. Extensive radiographic calcification in these patients is more likely to represent intramural rather than serosal or intraluminal calcification.

Calcinosis↗
PubMed1997

An unusual position of the gallbladder following nephrectomy for large neoplasms.

The cases of two children are presented in whom the gallbladder was found to lie in an unusual position in the ipsilateral renal fossa following nephrectomy for large neoplasms. This postoperative visceral position must be recognized, as the appearance on cross-sectional imaging can mimic postoperative fluid collections at the resection site or tumor recurrence.

Adolescent↗
PubMed1997

Large adrenal cysts in teenage girls: diagnosis and management.

Large adrenal cysts usually occur in the fifth and sixth decades of a patient's life but are rare in the first two decades. This paper presents the clinical, cross-sectional imaging, surgical, pathological and follow-up data of three teenage girls with large adrenal cysts. Two had vague upper abdominal pain and, in the other, the cyst was found incidentally. The cysts were surgically removed in two patients, while in the third, follow-up imaging has shown no change in the cyst over a 4-year period, suggesting that conservative management is a reasonable option.

Adolescent↗
PubMed1997

The diagnosis of malrotation during air enema procedure.

This paper describes the correct diagnosis of cecal malposition, suggesting midgut malrotation, during air enema examination in seven patients. It is possible to diagnose cecal malposition by air enema, even in the presence of a reducible intussusception.

Barium Sulfate↗
PubMed1997

The appearance of inverted Meckel diverticulum with intussusception on air enema.

This paper presents the appearances of inverted Meckel diverticulum with an irreducible intussusception on air enema in four children. The inverted Meckel diverticulum appeared as a bulbous (3) or triangular (1) filling defect in the air column projecting off the distal end of the soft tissue mass of the irreducible intussusceptum. The bulbous defect appears to be highly suggestive, and may be specific, for inverted Meckel diverticulum. Earlier recognition of the presence of the Meckel diverticulum as the lead point of the intussusception could have changed the management in two of the children.

Air↗
PubMed1997

Disappearing suprarenal masses in fetuses and infants.

This paper presents 12 infants (9 boys, 3 girls) in whom the diagnosis of a suprarenal mass (10 left, 2 bilateral) was made on antenatal sonography. All were otherwise healthy neonates who were born at term after a normal pregnancy, labor and delivery. The masses ranged from 1 to 3.5 cm in diameter on initial scans at gestational ages of 19-35 weeks. Eleven masses were hyperechoic and 4 of these contained small, well-defined cysts. The 12th was hypoechoic. Follow-up sonography showed complete disappearance of the mass antenatally in 1 case and postnatally by 4-6 months in 5 cases; there was marked diminution in the size of the mass by 2 months of age in 4 infants, by 4 months in 1 case and by 15 months in 1 case. Eleven were managed nonoperatively. Laparotomy (after disappearance of the mass) in the 12th case revealed only some fibrous tissue. The 11 echogenic masses resemble previously reported imaging findings in infants with histologically proven intra-abdominal sequestrated lung. Conservative management with careful sonographic follow-up should, therefore, be considered in otherwise healthy fetuses or neonates with these imaging findings. We are less certain what the hypoechoic mass represented.

Bronchopulmonary Sequestration↗
PubMed1996

Intussusception. Issues and controversies related to diagnosis and reduction.

Diagnosis and management of intussusception remain controversial. The authors discuss the evolution of changes and advances in practice and procedures. They advocate sonographic diagnosis and air enema reduction; the abdominal radiograph is reserved for children with clinical evidence of peritonitis and suspected perforation, if clinical findings are unusual, or if the sonographic examination is equivocal.

Air↗
PubMed1995

Perforation during attempted intussusception reduction in children--a comparison of perforation with barium and air.

This paper compares the effects on patients of perforation with barium and with air during attempted intussusception reduction by reviewing the clinical, radiological, surgical and pathological findings and sequelae in seven children who received barium and seven who received air. In both groups perforation occurred in infants under 6 months of age (with one exception) with a long duration of symptoms. All patients with barium enema required resection of bowel whereas only four with air enema required resection. Anesthetic times were longer in those patients with barium perforation in whom the intussusception did not move and there was a large leak. The patients with perforation due to air had a shorter hospital stay with decreased morbidity compared to those with perforation due to barium. Perforation occurred through areas of transmural necrosis in a minority of patients in each group. Perforations through normal bowel and shear injury (with air enema) indicate that increased pressure during the examination is an important factor in some patients. Because perforation with air is so much easier to deal with surgically and the children do better clinically, there is a tendency for some to consider perforation with air an inconsequential situation. However, a potential rare complication with this technique is tension pneumoperitoneum. Keeping this in mind, we continue to use air as the contrast of choice because the procedure in our hands is a safe, quicker and easier technique and we have achieved a substantial improvement in reduction rates. Overall reported perforation rates with air enema compare favourably with those due to barium enema.(ABSTRACT TRUNCATED AT 250 WORDS)

Air↗
PubMed1995

Partially reduced intussusception: when are repeated delayed reduction attempts appropriate?

The imaging techniques for diagnosis and monitoring of reduction of intussusception by fluoroscopy and ultrasound continue to evolve. The common goal of all protocols is to reduce the intussusception by enema in as many patients as possible and avoid laparotomy with its potential morbidity. We report two infants in whom the initial attempt at reduction by air enema only achieved partial reduction, from the descending colon to the transverse colon in one, and from the splenic flexure to the caecum in the other. Both patients became asymptomatic and clinically stable. In light of the clinical stability, and in consultation with the surgeons, laparotomy was deferred. Sonography was used to confirm the persistence of the intussusception before repeat air enema several hours later. Following three further air enemas in each child, the intussusceptions were successfully reduced after 20 h and 24 h respectively. Both patients remained asymptomatic and did not require surgery. In infants with partially reduced intussusception we suggest that if the patient becomes asymptomatic and stable, surgery can be safely delayed to permit further attempts at enema reduction. Sonography has a valuable role in determining the persistence of the intussusception prior to repeat enema. Close cooperation with the surgeon and careful clinical monitoring of the patient are essential requirements for this proposal.

Air↗
PubMed1995

Nephrocalcinosis and nephrolithiasis due to subcutaneous fat necrosis with hypercalcemia in two full-term asphyxiated neonates: sonographic findings.

Subcutaneous fat necrosis leading to hypercalcemia is rare but well documented in asphyxiated neonates. This paper presents two such neonates in whom sonography revealed the development of nephrocalcinosis and nephrolithiasis. The kidneys had initially been shown to be normal sonographically. In one infant, nephrocalcinosis developed as increasing echogenicity of the medullary pyramids. In the other, increased echogenicity of the renal cortex of uncertain cause developed together with nephrolithiasis. These sonographic appearances have not been described previously in this entity.

Asphyxia Neonatorum↗
PubMed1995

Tailoring the small-bowel follow-through examination postoperatively in gastroschisis patients.

The purpose of this paper is to establish a small-bowel follow-through (SBFT) protocol in post-operative gastroschisis patients. In 15 years, 19 SBFT examinations have been performed to diagnose or exclude obstruction in 61 gastroschisis patients. The average examination required 6.7 overhead films (range 3-15) and lasted 34 h (1-190 h). The diagnosis of intestinal obstruction was supported on SBFT in only 1 of 19 patients who underwent this examination. In the other 18, the examination showed no obstruction (13 patients) or was nonconclusive (5 patients). The inherent dysmotility associated with gastroschisis can result in redundant overhead films being made during SFBT. We recommend that an SBFT examination in gastroschisis patients consist of (1) fluoro-evaluation of esophagus, stomach, and duodenum; (2a) if normal peristalsis is noted, then an overhead film at 30 min, or (2b), if altered peristalsis or little movement of contrast medium is noted on the 30-min overhead film, then an overhead film at 4 and 12 h. This is followed by overhead films every 24 h if required. This protocol can result in a decrease in patient radiation, department costs, and staff work load.

Abdominal Muscles↗
PubMed1995

Bochdalek's hernia completely reduced by spontaneous ipsilateral tension pneumothorax.

This report describes a premature (29 weeks gestation) infant with a left Bochdalek's diaphragmatic hernia, in whom the development of a spontaneous ipsilateral tension pneumothorax caused complete reduction of the hernia into the abdomen. In the presence of a tension pneumothorax, a diaphragmatic hernia may be masked on a chest radiograph and therefore difficult to diagnose.

Hernia, Diaphragmatic↗
PubMed1995

Intussusception: ability of fluoroscopic images obtained during air enemas to depict lead points and other abnormalities.

PURPOSE: To evaluate the ability of fluoroscopic images obtained during air enemas to depict or exclude lead points of intussusceptions and other abnormalities that require surgical treatment in the absence of intussusception. MATERIALS AND METHODS: The clinical, radiologic, surgical, and pathologic findings were reviewed in 14 patients with lead points or other lesions. RESULTS: Fluoroscopic images failed to depict a lead point in 10 patients. The air enema easily reduced intussusceptions with benign lead points in seven patients. Fluoroscopic images depicted pathologic lead points in two patients and were normal in two patients with intussusception. Fluoroscopic images failed to depict an abnormality that required surgery in the absence of intussusception in two patients. CONCLUSION: Successful reduction of an intussusception does not always rule out a lead point. Other imaging studies, the patient's condition, and laparotomy may also be necessary to diagnose and treat lead points and other lesions.

Adolescent↗
PubMed1994

Intussusception: toward less surgery?

Since the 1950s, several large pediatric centers have used hydrostatic reduction with barium under fluoroscopic control as the treatment method of choice for ileocolic intussusception and have adopted rigid criteria for its management. One such rule has been that in order for an intussusception to be completely reduced, there must be adequate reflux of barium into the distal ileum. If this did not occur, it was assumed that the ileocolic intussusception had not been reduced, and the infant or child was taken straight to the operating room for laparotomy and surgical treatment. However, 10% of such intussusceptions were found to have reduced spontaneously. Needless to say, nonoperative management reduces morbidity and shortens hospitalization. From October 1985 through March 1991, 503 air contrast colon studies for suspected intussusception were performed on infants and children aged 2 days to 13 years (average, 16.8 months); 262 (52%) were normal, and 241 had an intussusception, 196 (81%) of which were reduced. The remaining 45 were operated on. In three patients (4 months to 2 years of age) the air enema reduced the intussusception from the colon without terminal ileum filling, but they all became asymptomatic immediately. For this reason they were not operated on; they were admitted and observed for 24 to 48 hours. Two of the three had recurrence of abdominal pain the next morning, but results of repeat air enemas were all normal (no intussusception observed, and normal terminal ileum filling).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Nephrocalcinosis in X-linked hypophosphataemic rickets: its relationship to treatment, kidney function, and growth.

We studied 25 patients treated with oral phosphate and 1,25(OH)2 vitamin D for 0.5-15 y (mean, 7 y) to determine the incidence of nephrocalcinosis and its relationship to treatment, renal function, and growth. During the follow-up period, 3 hypercalcaemic and 13 random hypercalciuric episodes were documented. Creatinine clearances and urine concentration tests were normal in all patients. One patient's 24-h urine specimen indicated hypercalciuria. Kidney ultrasonography revealed nephrocalcinosis in 80% of the patients, but its severity was not significantly related to the dose of calcitriol or of phosphate, the duration of treatment, the age at which treatment was started, or growth. None of the 9 untreated affected family members had nephrocalcinosis. Longitudinal studies revealed that the greatest loss in height velocity occurred during the first 2 y of life. Our study shows that nephrocalcinosis is a common complication of phosphate and 1,25(OH)2D3 treatment, but it is not necessarily associated with impaired renal function. Although the treatment failed to prevent a decrease in height velocity during infancy, it effectively maintained height velocity after 2 y of age.

Adolescent↗
PubMed1993

Retrograde percutaneous gastrostomy: a prospective study in 57 children.

We prospectively studied Retrograde Percutaneous Gastrostomy (RPG) in 57 children (age 3 weeks-17 years, 1.7-48 kg) as the feasibility and complications of this technique have not been reported in a large series of children. We used IV sedation (42), oral sedation (4 neonates), general anaesthesia or local anaesthesia only. The retrograde approach for gastrostomy or gastrojejunostomy catheter placement is described. Catheter placement was unsuccessful in only one child, due to the presence of marked hepatosplenomegaly. Catheters were successfully placed in all the other 56 children. In one of these, catheter misplacement occurred due to retraction of the stomach from the anterior abdominal wall during its insertion. This was recognized during the procedure. The catheter was removed and reinserted on the same occasion. One catheter was accidentally pulled out after six days and was subsequently replaced. Two children had mild, local abdominal tenderness and fever for up to 48 hours but post procedure septicemia or significant infection were not encountered. All children benefitted from gastrostomy feeding and gained weight.

Adolescent↗