Biomedical subjects
Publications and source records attributed to B J Cremin.
The maximum diameter of the common bile duct was measured on 85 normal intravenous cholangiograms carried out on children between the ages of 1--14 years. There was a close correlation between bile duct width and the patient's age, but a poor correlation with weight. The range of bile duct widths in each age group is tabulated as a guide to diagnosing biliary dilatation in childhood.
Four hundred and ninety-nine cases of osteo-articular tuberculosis have been analysed with special emphasis on the "unusual" presentation. Sclerotic bone reaction in association with active tuberculous osteitis is not at all uncommon and may occur in any affected bone. Maintenance of disc spaces with tuberculous spondylitis is not uncommon. Periosteal reactions, often very gross, occur commonly both in multicystic tuberculosis as well as in isolated lesions. Multiple bone involvement occurred in 8.2% of this series. Tomography delineates the total extent of involvement especially in central involvement of vertebral bodies. Healed tuberculosis may give rise to block vertebrae indistinguishable from the congenital type except for the absence of waisting at the level of fusion.
The radiological findings in five infants, with chondrodysplasia punctata, who died during the neonatal period are presented to illustrate the role of radiology in diagnosis and prognosis in this syndrome. Rhizomelic shortening of the limbs almost inevitably indicates an early demise. In the non-rhizomelic group, features such as excessive stippling and tracheal calcification are unreliable prognostic factors of early morbidity and mortality.
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Sphenoidal erosions due to tuberculosis are reported in four young coloured children. The lytic destruction is emphasized for refence texts indicate that tuberculosis produces a sclerotic reaction when extending to the skull base. Tuberculous osteitis of the skull occurs particularly in coloured children and adolescents. It should be considered when destructive skull lesions are seen in these patients.
The use of a silver nitrate impregnation technique and radiography for delineation of the bones of the developing skeleton is not widely known. Using this method, a study of skeleton development was undertaken over a three-year period and special attention was paid to 20 fetuses under the age of 16 weeks. The dates at which ossification in cartilage occurred and the sequence of bone development were noted. Although the technique may be used to delineate skeletal dysplasias in the stillborn, it is best suited to fetuses aged 9--20 weeks. It may become possible to show the earliest age at which bone dysplasias affect the skeleton though this is speculative at the moment.
A radiological study of the necropsy kidneys of 100 children was made. Morphologically it was shown that compound or fixed papillae predominate in the upper group of calyces and to a lesser degree in the lower group, whilst simple papillae occurred in the middle group. Pressure studies showed that intrarenal reflux occurred in compound papillae at lower pressure than in simple papillae and that lower pressures were required to produce intrarenal reflux in the first year of life.
Takayasu arteritis with renal artery involvement was the cause of severe persistent hypertension in eight children under 12 years of age. Features of severe hypertension dominated the clinical picture. Unequal or absent pulses were found in three patients. An irregular contour of the descending thoracic aorta on the chest roentgenogram was an early clue to the diagnosis. On aortography both renal arteries were affected in five patients, although a discrepancy in kidney size on excretory urography had suggested a unilateral lesion. Total aortography is mandatory to outline the full extent of the vascular abnormalities. All the patients had strongly positive tuberculin skin tests, and, although mycobacteria were not isolated, all patients received antituberculous as well as antihypertensive therapy. Nephrectomy of the worse kidney is contraindicated if the renal arteries are asymmetrically involved, for fear of later extension of the arteritis. Takayasu arteritis is an important cause of severe persistent hypertension in nonwhite children.
An ectopic ureterocoele may present as a diverticular-like structure at the bladder base appearing during voiding cystography. The radiological appearances are described and the mechanism of formation as seen in serial 70 mm film is discussed. The conventional intravesical filling defect of an ureterocoele may not be recognised when the bladder is filled by contrast medium. This sign of extra-vesical intra-ureteric invagination is only seen during voiding.
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Eighteen cases of Takayasu's arteritis in children under 14 years of age are described, emphasising the arteriographic features and noting differences with other series. Renal artery stenosis resulting in renal hypertension was the most significant finding but widespread involvement of the aorta and its main branches with predominantly stenotic lesions was also found. Total aortography is mandatory in these cases as without it the correct diagnosis cannot be made.
There are several types of short-limbed neonatal dwarfism. Before the delineation of thanatophoric dwarfism many dwarfs who died early in infancy were labeled "achondroplastic." Intrauterine radiological diagnosis is possible and the clinician may be alerted to the possibility of the condition by noting short squat limbs with a relatively large head on ultrasound examination, especially in cases of hydramnios.
Pseudoachondroplasia is a heterogeneous inherited skeletal dysplasia in which dwarfism is a major feature. Affected individuals have a normal craniofacial appearance and the skeletal malformations do not become apparent until early childhood. Radiographic changes observed in 13 affected individuals include shortening of tubular bones, flaring of metaphyses, variable epiphyseal maldevelopment and some degree of vertebral end-plate malformation. Diagnostic precision is essential for effective management and genetic counselling.
Choledochal cysts are predominantly a disease of children, the majority of which are female. The classical symptoms usually form part of a triad of jaundice, abdominal pain and a mass. The radiological features may be non specific and specific. Our experience of 21 cases with particular emphasis on the specific features which outline the cyst are presented.
The clinical and radiological findings seen in three babies born with characteristic limb defects are presented. These defects are thought to be due to intrauterine amniotic constricting bands rather than an endogenous developmental defect in the foetus. The theory of formation of bands is discussed.
The radiographic appearances of cranial and intracranial tuberculous lesions are reviewed. The manifestations of cranial and intracranial tuberculosis vary according to the location, severity of involvement and the chronicity of the disease.
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Sixteen cases of unilateral and 5 cases of bilateral traumatic renal artery occlusion caused by avulsion or thrombosis are presented. The injury typically follows automobile-pedestrian accidents to young male subjects. Associated extrarenal injuries are usual but non-pedicle renal injury is infrequent. Suspicion of the unilateral injury depends upon recognition of absence of visible excretion at urography. The clue to bilateral occlusion is anuria. Diagnosis is confirmed by urgent arteriography. Hematuria was absent in 24 per cent and the injury was missed at laparotomy in 29 per cent of the initial explorations. Renal function was salvaged by arterial reconstruction in 2 cases, 12 hours and 5 months after injury respectively. Hypertension developed in 50 per cent of the cases and was generally mild.