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Biomedical subjects

A Daneman

Publications and source records attributed to A Daneman.

At least 91 records · Page 5Linked to original sources
PubMed1989

Percutaneous aspiration, drainage, and biopsy in children.

Between 1983 and 1987, 44 infants and children had 50 percutaneous aspiration, drainage, and/or biopsy procedures under sedation and local anesthesia. Ultrasound occasionally supplemented by fluoroscopy was most commonly used as guidance. Results of all 17 aspirations without drainage helped in management. Eighteen of 25 aspirations with drainage were successful. The major clinical improvement was related to the initial decompression. Six of the eight biopsies were diagnostic. There were no complications or mortality. Our results show that percutaneous techniques can be performed safely and effectively in infants and children.

Adolescent↗
PubMed1988

Thyroid scanning, ultrasound, and serum thyroglobulin in determining the origin of congenital hypothyroidism.

Congenital hypothyroidism (CH) can be due to an absent gland (athyrosis), an ectopic gland (usually lingual), or an inborn metabolic error (goiter). In this study, radionuclide scanning was compared with ultrasound (US) and serum thyroglobulin (Tg) concentration as a method of determining the cause of CH in 50 newborns. Mean serum Tg values were significantly lower in athyrotic children (7.9 pmol/L) than in either those with goitrous (149.1 pmol/L) or ectopic (60.5 pmol/L) glands, but there was marked overlap among all three groups. With the interpreter "blinded" to the radionuclide diagnosis, a cervical gland could be delineated reliably on US. All 12 goiters and five of five normal glands were identified. In contrast, the correlation between US and radionuclide scanning was poor in patients in whom there was no cervical thyroid tissue. Ultrasound failed to identify 13 lingual glands and was reported as normal in four of 12 children with no radionuclide uptake in the neck and biochemical hypothyroidism. Two children with absent thyroid glands on scanning were biochemically euthyroid. The serum of two others who had normal results of radionuclide studies showed persistent hypothyroidism. Thyroid scanning remains the most accurate diagnostic modality to determine the cause of CH. Serum Tg and cervical US have not been established as reliable alternatives.

Choristoma↗
PubMed1988

Transient opacification of the urinary pathways by amorphous debris in children with leukemia.

Our index patient, a 14-year-old male on chemotherapy for acute lymphatic leukemia had extensive opacification of the urinary tract on the preliminary film for an intravenous urogram. Sonography and computed tomography also demonstrated dense material in the calyces, renal pelves and ureters. Since then, we have found another patient, a 9-year-old female with acute lymphatic leukemia who was not receiving chemotherapy, with a similar pattern on sonography and computed tomography. These densities unlike those in our first patient were not visible on a plain film of the abdomen. All of the material disappeared spontaneously in both patients.

Adolescent↗
PubMed1988

John Caffey Award. Intussusception reduction in children by rectal insufflation of air.

Air was used as the contrast medium for colonic studies in 282 patients with suspected intussusception. Intussusception was documented in 118 of these patients (42%), and reduction was achieved in 89 (75%) of those 118. Twenty-nine patients, in whom the intussusception could not be reduced with air, underwent surgery. Seven of these patients required surgical resection of devitalized bowel. In seven others, the intussusception was reduced by the surgeon with difficulty; in 12, surgical reduction was achieved easily. Three perforations occurred with the use of air. These patients were treated surgically without sequelae. This pilot study of 282 patients suggests that air is a safe substitute for hydrostatic reduction of intussusception.

Administration, Rectal↗
PubMed1988

Sonographic evaluation of spinal cord birth trauma with pathologic correlation.

Birth trauma to the spinal cord is a serious potential complication of delivery. Determining the presence, severity, and extent of injury poses a difficult problem because of the often confusing clinical setting. Myelography has been recommended for assessing spinal cord birth trauma but is invasive and may not be helpful. The role of sonography in evaluating spinal cord birth trauma has not been previously described. We assessed the value of sonography in four patients, three of whom also had CT metrizamide myelography. Autopsy correlation was available in three patients. Sonography was able to easily demonstrate the cord configuration, allowing for multiple assessments over time. Internal cord echogenicity was helpful in a case of hematomyelia and in demonstrating the changes of myelomalacia. Sonography is useful in evaluating neonates with severe spinal cord injury; it obviates the need for myelography and also may allow less severely injured patients to be assessed more frequently.

Birth Injuries↗
PubMed1988

The association of cystic fibrosis, gastroesophageal reflux, and reduced pulmonary function.

Between 1971 and 1984, 57 patients with cystic fibrosis (CF) and clinically suspected gastroesophageal reflux (GER) underwent a barium-meal examination and routine pulmonary function testing. Reflux was demonstrated in 18 patients; in six of these it was complicated by hiatus hernia, esophagitis, or stricture formation. Compared with 412 CF patients without known GER, the 18 patients with demonstrable reflux had significantly reduced forced expiratory volume and forced vital capacity. GER should be looked for carefully on any barium-meal study in patients with CF; these patients have an increased incidence of reflux, with its implications for lung function, and are not good candidates for surgical intervention.

Adolescent↗
PubMed1988

Real-time sonography of mediastinal and juxtamediastinal masses in infants and children.

Real-time sonography was used to evaluate 10 patients (age range, 2 days to 10 years) with mediastinal and juxtamediastinal masses. Seven of these also had computed tomography (CT). In eight patients sonography provided sufficient information with regard to probable diagnosis and adequate clinical management. CT was more helpful in two older children with postoperative seromas. Sonography is recommended as the imaging method of choice in neonates and in infants whose chest radiographs show mediastinal or juxtamediastinal masses. CT should be reserved for complex cases, and is of more value in older children.

Bronchopulmonary Sequestration↗
PubMed1987

Interposition of the gallbladder--or the absent common hepatic duct and cystic duct.

Interposition of the gallbladder is a rare anomaly, but its diagnosis is important since it represents a surgically correctable cause of jaundice. The patients present with jaundice, abdominal pain and sometimes an enlarged gallbladder. Radiological diagnosis may be difficult since the condition may be mistaken for a choledochal cyst, hydrops of the gallbladder or Caroli's disease. The ultrasound, cholangiogram and surgical findings of dilated intrahepatic ducts adjacent to a normal or enlarged gallbladder with no dilatation of the common bile duct are presented in two children with this condition.

Child, Preschool↗
PubMed1987

Blunt injury to the pancreas in children: selective management based on ultrasound.

Twenty-one children with blunt injuries to the pancreas were treated over a 5-year period. Group I consisted of 12 patients brought to our hospital within 24 hours of injury. Group II included nine patients who were referred to us more than 24 hours after injury following initial treatment at another hospital. Two group I patients died within four hours of admission from other causes. Three had early laparotomy for other injuries. Of these, two had a contusion and one had a complete transection of the pancreas. All recovered uneventfully after appropriate surgical treatment. The remaining seven were all treated nonoperatively. Two had obstructive pancreatitis secondary to duodenal hematomas, three had pancreatic contusions, and two developed pancreatic pseudocysts. All seven recovered completely without operation. In group II, three patients had undergone laparotomy elsewhere. All three had pancreatic contusions. However, only one had appropriate drainage of the injured pancreas; he recovered uneventfully. Two, who were not drained, developed pseudocysts and one of these required surgical drainage by cystgastrostomy. The other six patients in group II presented to our hospital with established pseudocysts. Three of these resolved with nonoperative treatment but three required drainage. Overall, six of ten posttraumatic pancreatic pseudocysts resolved without surgical treatment. The single most useful diagnostic test in the management of these patients was abdominal ultrasound (US). US revealed specific anatomic lesions of the pancreas--contusion, obstructive pancreatitis, or pseudocyst--and provided an objective guide to management. Surgical intervention is not necessary in all cases of pancreatic trauma.

Adolescent↗
PubMed1987

Congenital mesoblastic nephroma: a clinicoradiologic study of 17 cases representing the pathologic spectrum of the disease.

Congenital mesoblastic nephroma (CMN) is a rare infantile renal tumor with a generally excellent prognosis. We describe 17 tumors that fit into the pathologic spectrum of CMN proposed by Beckwith, which ranges from benign renal tumors, through atypical "gray zone" lesions of more aggressive potential, to "crossover" tumors akin to clear cell sarcoma of kidney. Nine patients with histologically typical CMN were significantly younger and had smaller tumors than did eight patients with atypical CMN. Clinical features did not differ in the two groups of patients. A distinctive "ring sign" on renal sonography was commonly seen in patients with typical intrarenal CMN. All 17 patients were alive with no evidence of disease at a mean follow-up of 10 years. Nephrectomy was adequate therapy for younger infants and for those with typical CMN. Nephrectomy was probably also adequate therapy for infants 3 months of age or younger with atypical CMN, even if the tumor extended to the surgical resection margins and into the perinephric connective tissues. Adjuvant chemotherapy or radiation or both should be reserved for patients older than 3 months who have grossly unresected tumors and for those patients whose tumors have an unequivocally malignant histologic appearance or evidence of aggressive biologic behavior.

Age Factors↗
PubMed1987

Lymphoid follicular pattern in the colon: an indicator of barium coating.

A lymphoid follicular pattern was noted more frequently when high-density (100% w/v) replaced low-density (58% w/v) barium in children undergoing double-contrast barium enema examinations. Therefore, a retrospective study was undertaken to compare the presence of follicles seen in 24 consecutive patients under 10 years old given low-density barium with that of 50 patients given high-density barium. The high-density studies revealed follicles in 90% of the children compared with 46% of the children having low-density studies. All follicles were less than 2 mm in diameter. An aphthoid appearance was present in nine of these 50 children. The most common indications for the high-density examination were rectal bleeding and abdominal pain. The final diagnosis was normal bowel in more than two thirds; no child under six years old given high-density barium had inflammatory bowel disease. There was no correlation between final clinical diagnosis and the presence, extent, or severity of the lymphoid follicular pattern.

Barium Sulfate↗
PubMed1986

Behçet's syndrome involving the gastrointestinal tract--a diagnostic dilemma in childhood.

Behçet's syndrome is very rare in children, especially those under 10 years of age. Clinical and radiological features are described in 4 children, including 2 under the age of 5 years, with the syndrome. As in other pediatric cases reported, the incomplete form of Behçet's syndrome was present in each case. All 4 patients had oral and genital mucosal effects, arthritis and gastrointestinal and dermatological manifestations. Ophthalmological symptoms occurred in only 1 patient. Radiologically, the 4 cases demonstrated the spectrum of gastrointestinal involvement, from minimal irregularity and thickening of the terminal ileum to gross irregularity and deformity of the terminal ileum and cecum. Because of the difficulty in differentiating Behçet's syndrome from other forms of inflammatory bowel disease it is suggested that in children with gastrointestinal involvement, 3 major criteria be present before the diagnosis of Behçet's syndrome is made.

Adult↗