Biomedical subjects
Publications and source records attributed to B J Cremin.
Two cases of abdominal abscesses related to the falciform ligament are described. The importance of ultrasonic localization is stressed, as these extrahepatic abscesses require surgical drainage, whereas an intrahepatic abscess, particularly amoebic, may be treated with antimicrobials.
Full-term as well as preterm infants are liable to cerebral haemorrhage. Not all paediatricians are aware of this, but the availability of ultrasound in many general hospitals which have paediatric beds is alerting them to this possibility. This account draws on a two-year experience at a paediatric institute to which full-term infants with neurological symptoms were referred from a wide area. During this time 23 cases were diagnosed and cases illustrating the spectrum are presented.
Most of the paediatric abdomen can be evaluated ultrasonically by a real-time subcostal approach. A basic technique is given using four standard sites. The anatomy that is visualised at these sites is described in simple detail. The major differences between adults and children are listed. Problems of recognition between normal and paediatric variations are commented on, and size measurements of various organs at different ages are tabulated.
A prospective study to determine the prevalence rates of rickets, as determined by clinical, biochemical and radiological examinations performed at the age of 12 months in preterm infants of low birth weight and full-term control infants of mothers in lower socio-economic classes, was carried out. Clinical rickets was suspected in 5 cases. Biochemical and/or radiological evidence of rickets was not evident in any of the infants studied, although 4 infants showed radiological evidence of osteopenia. Serum alkaline phosphatase and 25-hydroxycholecalciferol levels showed significant seasonal variations. Serum zinc and copper levels were within normal ranges for age. The true prevalence rate of rickets during infancy among the prematurely born or full-term infants in Cape Town is not known. The findings of our study show that as long as the mother utilizes the available community health services her infant should not develop nutritional rickets by the age of 12 months.
A case of post-traumatic infantile subdural effusion is reported in which spontaneous resolution did not occur. The patient developed features of raised intracranial pressure 1 month after a head injury and required drainage of the persistent effusions followed by shunting of the hydrocephalus. The pathology and management of subdural effusions are discussed.
Subdural collections in infants are common complications of meningitis, trauma and post surgical procedures. Careful ultrasonic examination via the anterior fontanelle is a reliable method of demonstrating these collections. It has an accuracy comparable to computed tomography and is our first line of investigation.
Real-time ultrasonography was performed, utilising the patent anterior fontanelle, on 82 infants with viral or bacterial meningitis. One third of the cases had normal ultrasonic appearances. The other two thirds demonstrated abnormalities of the subdural space, parenchyma and ventricles. Ventricular dilatation was the commonest abnormality and was present in 57% of the infants; ultrasonic evaluation was used to monitor the progress of treatment of these patients.
In the infant the cranial and abdominal complications of ventriculoperitoneal shunting can be assessed by real-time ultrasound via the anterior cranial fontanelle or the abdominal wall. The possible complications are listed and eight cases document the spectrum.
Real time ultrasound is an excellent method of detecting cystic lesions in the child's abdomen. Its accuracy in the diagnosis of intestinal duplication cysts is enhanced when it is followed by a barium study. These cysts may present a variety of ultrasonic appearances and the spectrum of findings is well represented by three consecutive cases diagnosed in 1983.
Paediatric abdominal CT often has to be performed outside a children's hospital. Without careful planning, the examination can be unrewarding and full of snags, and our technique for these conditions is outlined. Some of the problems of whole body CT are discussed and the examination has been found to be of the greatest value in children with extensive retroperitoneal and pelvic masses. In these circumstances it may be used for both diagnosis and treatment follow-up, and the benefits it provides justify any increased radiation to the patient.
The availability of real time ultrasound units with small transducer heads has made perineal ultrasonography a practical proposition in infants. The findings of a dilated posterior urethra and bladder obstruction in a male infant indicate the high probability of a posterior urethral valve. The features seen in the urethra as well as those in the bladder and kidneys are demonstrated.
Real time ultrasound via the anterior fontanelle in infants is a frequent examination. Six coronal and three sagittal planes are defined and described. These give consistent landmarks with which normal and abnormal anatomy can be correlated. The anatomy was confirmed by cutting and correlating autopsy brains at the same angulation.
A simple definition and classification of intracranial cysts and porencephaly is difficult, if not impossible. A working ultrasonic classification for CSF-containing cysts is provided, based on their character and geography. Five cases of differing CSF-containing cysts in the neonatal head are discussed, with correlated ultrasound and computed tomographic studies.
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Biliary ascariasis is not an uncommon paediatric problem in Cape Town. Real-time ultrasound examination offers a rapid method of diagnosis and treatment monitoring. In transverse scans, a 'triple echo' of gallbladder, dilated main bile duct and portal vein can be recognized. The worm gives an intense 'bull's-eye' echo within the duct and its tubular structure can be followed ultrasonically.
Anterior fontanelle real-time ultrasonography is a method for the rapid diagnosis and evaluation of hydrocephalus. It may be used in infants up to the age of at least 18 months. It has replaced the need for computed tomography in these patients and will become an essential part of neonatal neurology in the future.
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