Biomedical subjects

C E Blane

Publications and source records attributed to C E Blane.

At least 37 records · Page 2Linked to original sources

PubMed1994

Bladder diverticula in children.

PURPOSE: The frequency, number, and underlying associations of bladder diverticula were studied in a pediatric population. MATERIALS AND METHODS: Eighty-five children with bladder diverticula (31 girls and 54 boys) were retrospectively identified in a pediatric genitourinary data base of 5,084 children. RESULTS: Primary bladder diverticula were seen in 20 children with vesicoureteral reflux and 14 children without reflux. Fifty-one of the 85 children (60%) had associated neurogenic dysfunction of the bladder (n = 26), outlet obstruction (n = 14), or a syndrome (n = 9) or were postoperative (n = 2). A single child of the 26 with multiple bladder diverticula had no associated condition. CONCLUSION: In this population, bladder diverticula were found in 1.7% of the children. The presence of more than one diverticulum on a side was usually associated with neurogenic dysfunction of the bladder, bladder outlet obstruction, or syndromes such as Williams, Menkes, prune-belly, or Ehlers-Danlos type 9 syndromes.

Abnormalities, Multiple↗

PubMed1993

Perforation associated with barium enema in acute appendicitis.

A child with the suspected diagnosis of atypical acute appendicitis underwent a diagnostic barium enema. The study was complicated by perforation with leakage of a large amount of barium into the peritoneal cavity. The complex hospital course that resulted has prompted us to reevaluate the barium enema in the diagnosis of appendicitis and review the literature for contraindications. We conclude that this particular complication is extremely rare and that barium enema still has a part to play in some patients where the clinical diagnosis is uncertain.

Acute Disease↗

PubMed1993

Renal sonography is not a reliable screening examination for vesicoureteral reflux.

A retrospective analysis of 493 infants and children was performed to determine the reliability of renal sonography for identifying vesicoureteral reflux. Sonography was done in all cases within 8 hours of a voiding cystourethrogram. Vesicoureteral reflux was documented in 272 of 986 kidneys on voiding cystourethrography and there were 201 refluxing kidneys with normal ultrasound (25 with grade I reflux, 119 with grade II, 50 with grade III, 6 with grade IV and 1 with grade V). In 71 of the refluxing kidneys the ultrasound was abnormal due to pelvicaliceal dilatation in 45, a duplication anomaly in 6 and renal fossae abnormality in 20. Of the kidneys with vesicoureteral reflux 74% were sonographically normal. Sonography was not sufficiently sensitive or specific for detecting vesicoureteral reflux, since 28% of the missed refluxing kidneys had grade III or higher reflux.

Adolescent↗

PubMed1993

Old renal transplants examined by Doppler ultrasonography.

Twenty-four ultrasonography (US) studies of 21 renal transplants that had been in place for 1 to 19 (median 3) years were evaluated. The absolute resistive indices (RIs) determined during Doppler US at various arterial levels and the differences in RI between the levels did not correlate with the clinical diagnosis of chronic rejection. This study suggests that measuring RI values with Doppler US in people who received renal grafts as children does not currently contribute additional information for diagnosis or management.

Adolescent↗

PubMed1993

Doppler ultrasonography in the early postoperative evaluation of renal transplants in children.

The renal ultrasonography (US) scans of 23 children who had recently undergone kidney transplantation were reviewed; the studies included Doppler US scanning of the arterial vessels at several levels. There were 43 studies for children whose postoperative course was normal; 16 studies were obtained during episodes of acute tubular necrosis and 21 during episodes of acute rejection. The upper limit of normal for the resistive index (RI) at the arcuate artery is higher (up to 0.79) for a pediatric renal transplant patient than for adults with normal kidneys, regardless of the age of the kidney donor. Therefore, elevation of the RI to 0.80 or higher or complete loss of diastolic flow always indicates a complication of transplantation. Abnormally high RI values were seen in patients with both acute tubular necrosis and acute rejection; however, the RI value as determined by US did not distinguish these two entities. In addition, in 7 cases of acute tubular necrosis and 12 of acute rejection the RI was normal (0.58 to 0.79).

Adolescent↗

PubMed1992

Single system ectopic ureters and ureteroceles associated with dysplastic kidney.

Eight children forming an uncommon subgroup of renal obstructive dysplasia are presented. Each child had a nonfunctioning dysplastic kidney with a single collecting system with ectopic ureteral insertion and/or ureterocele. Five of the children had classic multicystic dysplastic kidneys, one had the hydronephrotic type of multicystic dysplastic kidney and two had hypoplastic kidneys. Other significant medical problems in 5 of the 8 children (63%) included VACTERL association, congenital heart disease and other genitourinary malformations. Unlike some children with unilateral multicystic dysplastic kidney, this subgroup of children has an increased risk of infection. They must be correctly identified on imaging so that tailored clinical management decisions can be made and associated anomalies detected.

Abnormalities, Multiple↗

PubMed1992

First-year medical students' attitudes toward radiology.

To explore the perspectives of entering medical students, a questionnaire was completed anonymously by 171 students in September of their first year of medical school. The authors investigated their attitudes toward radiology relative to other specialties and their perspective concerning which factors would influence their eventual choice of a specialty. Upon entering medical school, 33.3% of the students indicated that they had chosen a specialty, and 7.4% of these students had selected radiology. Radiology was perceived as a well-paid specialty with a pleasant lifestyle. These are factors that were perceived as very important regarding influence on eventual choice of specialty. However, radiology was believed to have an undesirably low level of patient contact and was perceived as not being intellectually exciting. We plan to follow this group of students prospectively through medical school to see whether their attitudes change toward radiology as a career.

Adult↗

PubMed1991

Radiographic imaging for Ilizarov limb lengthening in children.

The Ilizarov method for limb lengthening is rapidly gaining popularity in North America. Use of this new technique has necessitated modifications in radiographic protocol. Initial imaging problems gained from our experience with twenty children are detailed including accurate centering for the plain films, correcting for magnification to accurately measure the distraction gap and the expected radiographic appearance of the regenerate bone. Ultrasonography has potential value in accurately measuring the distraction gap and in imaging the new bone prior to radiographic appearance. Since overly fast distraction inhibits bone formation and overly slow distraction leads to premature consolidation, ultrasound may serve a useful role in the qualitative evaluation of new bone formation in Ilizarov limb lengthening, enabling the orthopedic surgeon to tailor the distraction rate to the particular child.

Bone Development↗

PubMed1991

Renal obstructive dysplasia: ultrasound diagnosis and therapeutic implications.

57 cases of renal obstructive dysplasia (defined as the abnormal development of nephronic and ductal structures due to in utero obstruction of the urinary tract) were evaluated in terms of sonographic findings, renal and other associated anomalies, and current status of the child. More than one-third of the cases had bilateral disease and although not uniformly fatal bilateral involvement was associated with significant morbidity and mortality. In 12 of the 33 cases with unilateral dysplasia there was an association with contralateral renal problems including uretero-pelvic junction obstruction, vesicoureteral reflux and aplasia. Almost one-half of the cases had congenital anomalies, these included VACTERL association, congenital heart disease, cranial abnormalities and gastrointestinal malformations. Fifteen stillborns and 12 of the patients with bilateral involvement and four with unilateral involvement have died. Four patients are on dialysis (two with bilateral involvement and two with unilateral renal obstructive dysplasia). Only one-quarter are otherwise normal. More serious problems are reported in this mixed age population of patients with obstructive renal dysplasia than has been identified in previous studies. Management decisions of the fetus and child must be based on this new age-expanded population.

Abnormalities, Multiple↗

PubMed1991

Familial cervical dysplasia.

Nine of twelve family members from three generations were affected by an inherited form of cervical vertebral dysplasia. All of the affected people had an abnormality of the first cervical vertebra. Some also had defects of the axis and caudad to it. The mode of transmission of the disorder is autosomal dominant, with apparently complete penetrance and variable expressivity. Two patients had symptoms. One had a passively correctable tilt of the head, with an associated audible clunk and hypoplasia of the left superior facet of the second cervical vertebra. This patient had no local symptoms, neurological involvement, or muscle spasm. In the other patient, suboccipital pain developed. Radiographs revealed an anterior atlanto-occipital dislocation. The symptoms resolved after reduction and arthrodesis. Because of the apparently complete penetrance of this disorder, physicians caring for patients who have this type of congenital malformation of the cervical spine should consider examination of closely related members of the family. Clinical findings such as tilting of the head, torticollis, or limitation of cervical motion suggest that additional evaluation should be done. The examination should include lateral radiographs of the cervical spine in flexion and extension. Three-dimensional computed-tomography reformatting was helpful in demonstrating the complex cervical anatomy in our patients. Patients who have recognized abnormalities should be followed and should be re-examined whenever local or neurological symptoms develop. A magnetic resonance image of the spine in flexion and extension was valuable for identification of the potentially disastrous situation of impending damage to the cord in patients who had instability and evolving symptoms.

Adult↗

PubMed1989

Ultrasound diagnosis of evolving pyloric stenosis.

Two infants with recurrent episodes of vomiting had upper gastrointestinal barium studies that did not show radiographic features of pyloric stenosis. However, follow-up abdominal sonograms done 1-2 weeks later documented hypertrophic pyloric stenosis, which led to surgery. This entity is not congenital, but an evolving acquired lesion. Therefore, ultrasound is an excellent modality to evaluate and monitor patients clinically suspected of developing hypertrophic pyloric stenosis despite their initially negative imaging studies.

Humans↗

PubMed1989

Follow-up imaging of benign pediatric liver tumors.

Though surgery has been recommended in the past for the management of benign hepatic tumors, the current emphasis is on medical management. This report of 4 cases with long-term (8-28 months) follow-up emphasizes the natural history of these tumors which serves to indicate the advantages and disadvantages of CT and ultrasound. The lesions typically involute with some calcification. Calcification can technically be a problem in follow-up with sonography.

Carcinoma, Hepatocellular↗

PubMed1989

Long-term radiographic follow-up of the Nissen fundoplication in children.

This study examined 46 children 5-9 years (mean 6.7) after Nissen fundoplication surgery for gastroesophageal reflux (GER). Eleven were deceased and ten of the 35 families declined objective evaluation. The remaining 25 children (71%) had a barium swallow examination. In 16 of the 25 patients the fundoplication was intact. In 2 patients a small portion of the fundoplication was displaced above the diaphragm. In 5 patients there was residual esophageal disease. In 3 patients (one with esophageal disease), with a hiatus hernia prior to surgery, despite immediate postoperative reduction, the barium swallow examination done for this study revealed recurrent hiatus hernia but no GER. Long-term results of the Nissen fundoplication reveal success in eliminating clinically significant gastroesophageal reflux. Those patients with esophageal disease prior to the surgery need close interval follow-up to monitor continuing problems.

Child↗

PubMed1989

Medical student attitudes toward radiology. A multi-institutional survey.

A questionnaire was administered to 238 students at four institutions before and after a radiology clerkship to evaluate student attitudes regarding radiology as a career, radiologist expertise, and clerkship expectations. There was no statistically significant difference among the clerkships, although they varied in types of experience, geographic location, and size. After the clerkship, the students agreed more strongly that the radiologist should be involved in patient workup, screening of requests, interpretation of emergency room films, and consultations. A significant change in attitude could be identified after the four-week experience, indicating a desire for the radiologist to have a more active role as imaging consultant.

Attitude of Health Personnel↗

PubMed1989

Problem-solving model in radiology for medical students.

Current undergraduate medical education is criticized for not preparing physicians to be independent thinkers. The rapid development of new imaging techniques and the problem of escalating medical costs call for efficient patient management. The development of algorithms in imaging work-up of patient problems is an excellent example of problem solving or medical decision making. The senior elective in radiology at our institution incorporates this type of problem-solving session. Small groups (15-25 students) with faculty guidance discuss 5-6 common patient problems to develop an investigative plan in imaging. Algorithms are thus developed by the group, but not presented for memorization. Small changes are then made in the case history so that the students are forced to make new hypotheses and generate a modified algorithm. Correlative costs are included. Flexibility and initiative in development of patient management algorithms are stressed.

Clinical Clerkship↗

PubMed1989

Late results of fundoplication for gastroesophageal reflux in infants and children.

The Nissen fundoplication (NFP) for the management of severe gastroesophageal reflux (GER) in infants and children has become one of the most frequently performed operations in pediatric surgical centers in the United States. Short-term outcome, morbidity, and mortality are consistently favorable in several large series. The long-term success of this procedure is presumed but has not been established objectively. To examine the late results of this operation, 46 infants and children were carefully evaluated more than 5 years after NFP (mean, 6.7 years). Evaluation included parental interview, physical examination, upper gastrointestinal series, and esophageal pH monitoring. The mean age at the time of operation was 4.13 years. Fifty-seven percent of the patients had significant neurologic impairment, and 80% had at least one serious additional medical problem. Twenty-four percent of the children died during the period of follow-up--all but one death related to serious underlying medical problems. Of the 35 survivors, 26 (74.3%) have no symptoms; five (14.3%) have mild symptoms potentially referable to GER that necessitate little if any treatment; four (11.5%) have had symptomatic recurrence of GER necessitating repeat fundoplication. Three of these patients now have no symptoms. Forty-five percent of the patients had at least one postoperative complication. NFP provides efficacious, long-term treatment of GER in infants and children, with acceptable morbidity. Mortality in this group of children is related primarily to associated diseases rather than to GER.

Adolescent↗

PubMed1988

Percutaneous nephrostogram in the newborn with bilateral renal cystic disease.

Percutaneous antegrade pyelography should be considered in the few, select, critically ill newborns with bilateral renal cystic disease when the diagnosis is critical to management and difficult with the usual imaging procedures. Two extremely ill newborns with severe oliguria and cystic abnormalities in both kidneys by ultrasound underwent sonographic guidance for percutaneous antegrade nephrostograms in the first week of life. With injection of contrast medium, definitive diagnoses were made of a multicystic dysplastic kidney on one side and an obstructed hydronephrotic kidney on the other, thereby directing decompression of the obstructed kidney to preserve native renal function. This procedure can provide a definitive diagnosis in these rare but difficult cases.

Humans↗

PubMed1988

Journal publications in radiology education. A review of the literature, 1966-1986.

Published scholarly activity pertaining to radiology education is relatively uncommon compared with an extensive clinical literature. To guide future radiology educational efforts in a time of changing priorities and practice patterns, the authors undertook an in-depth review and analysis of the existing radiology education literature covering the 20-year period from 1966 to 1986. A total of 194 articles was identified via a computerized literature search and manual cross-checking of cited references. Articles pertinent to medical student radiology education (36.6%) or radiology resident education (29.9%) predominated. The majority of published radiology education articles were editorials (35.5%) or expository in nature (49.5%). Surveys (5.1%) and experimental research (8.7%) comprised the balance. Although editorial opinions and personal reflections are important and valuable resources for radiology educators, a substantial lack of empirical research in radiology education exists. Additional knowledge in underdeveloped research areas is essential for future curriculum planning and development in radiology education.

Bibliographies as Topic↗