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Biomedical subjects

C R Fitz

Publications and source records attributed to C R Fitz.

At least 55 records · Page 3Linked to original sources
PubMed1983

Hypoxic/ischaemic cerebral injury in the neonatal brain. A report of sonographic features with computed tomographic correlation.

Ultrasound has been used in 11 neonates whose history or clinical features suggested the possibility of hypoxic/ischaemic lesions. The ultrasound findings were correlated with computed tomographic findings in nine infants and with pathological findings in two. On ultrasound scan, areas of increased echoes represented both hypoxic/ischaemic and haemorrhagic lesions. However, the distinction between them could not be made with certainty. Cystic changes were shown clearly by ultrasound as were cerebral vascular pulsations in and adjacent to the areas of increased echoes. With computed tomography, hypoxic/ischaemic lesions were represented by areas of decreased density and haemorrhagic lesions by areas of increased density. Computed tomography failed to clearly demonstrate the cystic changes. Three types of lesions, viz. diffuse, focal and periventricular were based on the location of brain injury, the former two occurring in term infants and the latter in premature infants. Ultrasound has been shown to be of value for definition of the site and extent of hypoxic/ischaemic cerebral lesions in the newborn and for observation of their evolution.

Brain Ischemia↗
PubMed1983

Computed tomography and lymphogram correlation in children with Hodgkin's disease.

In 17 children with Hodgkin's disease, abdominal computed tomography (CT) and bipedal lymphangiography findings were correlated in an attempt to assess the accuracy of CT in excluding the presence of retroperitoneal and pelvic lymphadenopathy. There was excellent correlation in 14 (82%) patients. In 13 of these, both studies were negative; in one, enlarged nodes were noted in the pelvis on both studies, which otherwise revealed no abnormality in the remainder of the abdomen. In one other patient, CT revealed lymphadenopathy high in the abdomen and these nodes were not filled with contrast medium at lymphangiography. Lymphangiography revealed pelvic lymphadenopathy in 2 (12%) patients in whom the CT scan was initially interpreted as normal. If strict attention is paid to adequate opacification of the bowel and retroperitoneal vasculature, CT is an accurate modality for excluding retroperitoneal and pelvic lymphadenopathy, particularly in older children.

Adolescent↗
PubMed1983

Diagnostic accuracy of neonatal brain imaging: a postmortem correlation of computed tomography and ultrasound scans.

The aim of this study was to validate brain imaging techniques in the preterm infant. A homogeneous group of very immature (less than 32 week) neonates dying in the neonatal period were sequentially scanned with linear-array real-time ultrasound scans, and after death with compound B static sector ultrasound and high-resolution computed tomography (CT) scans. All three imaging techniques were correlated with the autopsy results. All germinal matrix bleeds greater than 5mm in size and intraventricular hemorrhages associated with ventricular dilation or distortion were accurately diagnosed. In the immature infant it was difficult to distinguish the normal highly vascular germinal matrix and choroid plexus from hemorrhage into the brain or ventricles, respectively. Further studies that address the questions of accurate timing and incidence of bleeds must consider the spatial resolution of the individual scanner, the maturity of the brain, the site and size of the lesion, and the evolution of the lesion. For the diagnosis of major hemorrhagic lesions in the preterm infant, either ultrasound or CT scans may be used with confidence.

Brain↗
PubMed1983

Neuroradiology of posterior fossa tumors in children.

In the examination of posterior fossa tumors, I believe that few findings are worthy of the term diagnostic. The small multiple focal calcifications of ependymomas are probably one such event, but it occurred in only 3 of the 124 tumors in this series. The large calcifications of medulloblastoma also seem to be close to a diagnostic sign, but this is also relatively uncommon. Extension to the midbrain or cerebellopontine angle in a large solid tumor is also fairly specific for medulloblastoma. A homogeneously decreased density before intravenous contrast seems to hold up as a sign of an astrocytoma in both this series and previously reported cases. Large cysts of the type typical for astrocytoma are quite uncommon in nonastrocytomas, but they do occur. Small cysts or cysts of any size in tumors that are less than 4 cm in total diameter are nonspecific findings, as are solid or cystic tumors whose solid portions are of mixed density. The relatively tumor-specific findings of the characteristic calcifications, low density and cysts of astrocytoma, and homogeneously hyperdense medulloblastomas account for approximately half of the tumors. Most of the remaining half can be accurately diagnosed by using combinations of size, location, and more general characteristics of density and contrast enhancement.

Adolescent↗
PubMed1983

Intracranial vascular malformations in children: computed tomographic and angiographic evaluation.

Thirty-nine cases of intracranial vascular malformations in children were reviewed. All patients underwent preoperative computed tomography (CT) and 35 had complete preoperative angiographic work-ups. The CT features of intracranial vascular malformations in children are described. Among the 39 patients, there were 30 parenchymal arteriovenous malformations, four dural arteriovenous malformations, three cavernous angiomas, and two venous angiomas. Combined CT and angiography allowed a highly specific diagnosis in 77% of the cases.

Adolescent↗
PubMed1983

Focal ischemic cerebral injury in the newborn: diagnosis by ultrasound and correlation with computed tomographic scan.

Ischemic brain injury in the newborn is a common cause of subsequent neurologic deficits seen in older children. Clearly, determination of severity and location of such injury is important for management and prognosis. Although ultrasound scanning of the brain has been used extensively in the premature infant for diagnosis of hemorrhagic lesions, its use in the term infant for recognition of ischemic cerebral lesions has not been reported. Four cases are described in which focal echodense areas were identified on ultrasound scan of the brain. These echodense areas on ultrasound corresponded to the appearance on computed tomographic (CT) scan of areas of decreased density which are known to represent ischemic cerebral injury. In three of the four cases there were focal neurologic findings and/or focal abnormalities on EEG. In two cases, real-time ultrasound scanning demonstrated changes in arterial pulsations in cerebral vessels in the area of the lesions. Thus in both, there was diminution in pulsations within the echodense areas and in one case, an increase in pulsations was observed at the periphery of the echodense lesion. Our data demonstrate the value of ultrasound scanning for assessment of the extent and location of focal cerebral ischemic lesions in the newborn. Such assessment permits assessment of prognosis.

Brain Ischemia↗
PubMed1982

The prognostic value of computed tomography of the brain in asphyxiated premature infants.

Computed tomography brain scans were done during the first two weeks of life in 145 asphyxiated or apneic newborn infants with birth weights less than 1,500 gm. Sixty-two survived and were assessed neurodevelopmentally at 18 months from the term date. Follow-up CT scans were done at six months post term. There were major neurodevelopmental defects in 15 children, minor defects in 10, and no gross abnormalities in 37. The neonatal CT scans showed germinal layer hemorrhage in 45 (73%) of the survivors and was combined with ventricular bleeding in 29 cases (47%). Areas of hypodensity of brain tissue were present in all neonatal CT and were extensive in 84%. Ventricular dilatation occurred in 31%. There was a significant relationship between hydrocephalus and CT findings of IVH and dilated ventricles, but no relationship between outcome at 18 months and any other features of the neonatal CT. Only four of 56 CT scans done at six months post term were normal. Dilatation of the ventricles and subarachnoid spaces was common but was not related to subsequent neurodevelopmental status.

Asphyxia Neonatorum↗
PubMed1982

Conventional metrizamide myelography (MM) and computed tomographic metrizamide myelography (CTMM) in scoliosis. A comparative study.

A retrospective examination was performed to assess the accuracy of metrizamide myelography (MM) and computed tomographic metrizamide myelography (CTMM) in scoliosis. Of 81 consecutive scoliotic children studied by myelography, 30 had only MM while the remaining 51 had CTMM immediately afterward. CTMM added essential diagnostic information in 13 cases of dysraphism and 4 cases of idiopathic scoliosis; in the remaining cases, both methods gave the same information. The authors conclude that in patients with severe scoliosis, dysraphism, and scoliosis with localized neurological disturbances, CTMM should always be added to MM or be the only examination; while in idiopathic scoliosis with vague neurological disturbances a survey of the entire spine is essential, preferably with MM.

Adolescent↗
PubMed1982

Intracranial neoplasms in children: the effect of computed tomography on age distribution.

In a review of all children with brain neoplasms evaluated at a large pediatric center during a three-year period following the introduction of computed tomography (CT), a change was observed in the age distribution at the time of clinical presentation as compared with a previous series evaluated prior to the introduction of CT. In children under six years of age, there was a highly significant trend for earlier diagnosis; within this age group, relatively more children were diagnosed in the first two years of life. Between six and twelve years of age, there was no change in frequency of brain tumor diagnosis between the two series. Above age twelve, there was again noted a highly significant increase in detection of brain tumors in the more recent series. These differences between the two series may be attributed, at least in part, to earlier referral and diagnosis since the advent of CT, although other factors cannot be excluded as possible causes of the differences.

Adolescent↗
PubMed1982

Adverse reactions to myelography with metrizamide in infants, children and adolescents. I. General and CNS effects.

A prospective investigation of the adverse effects of myelography with metrizamide was performed in a series of 250 examinations in infants, children and adolescents. Adverse reactions occurred in 58 per cent of all cases. The majority of these were mild, and seemed to be due to the lumbar puncture alone. The frequency of the moderate and marked reactions was directly related to the total amount of metrizamide given and to the cranial extension of the examination in the spinal canal. No other circumstances around the procedure had any impact on the occurrence of adverse reactions.

Adolescent↗
PubMed1982

Adverse reactions to myelography with metrizamide in infants, children and adolescents. II. Local injury caused by lumbar puncture and injection of contrast medium.

A series of 605 myelographies with metrizamide was reviewed to assess the risk of local injury caused by the puncture and injection of metrizamide. A lesion below the normal level of the medullary conus was found in 139 patients, and in 10 of these the needle went into or through the lesion. One patient developed paraplegia due to the puncture and injection, no other patient had any symptoms. It is concluded that in spite of the risk, lumbar puncture should be the routine procedure for myelography with metrizamide in children.

Adolescent↗
PubMed1981

The intelligence of hydrocephalic children.

In a group of 78 children with hydrocephalus in the first months of life, the level and pattern of intelligence were considered in relation to various parameters and symptoms of their condition. These included demography (age, sex, handedness); early developmental status; symptoms (visual, motor, and seizure); formative pathology; type of hydrocephalus; site of CSF obstruction; extent and configuration of cortical thinning; and shunt treatment. The common outcome of early hydrocephalus is an uneven growth of intelligence during childhood, with nonverbal intelligence developing less well than verbal intelligence. The origin of this selective cognitive deficit is in neither the hydrocephalic condition itself nor its treatment, but rather in the developmental brain anomalies and symptoms to which the hydrocephalic child is prone: In children with aqueduct blocks and intraventricular hydrocephalus, a selectively thin vertex and occipital lobe; in any hydrocephalic child, ocular abnormalities, motor deficits, and seizures.

Age Factors↗
PubMed1981

Tuberous sclerosis complex in children.

Of 62 children seen at The Hospital for Sick Children, Toronto, who had tuberous sclerosis (TS), 58 had a history of seizures (developing during the first year of life in 37) and mental retardation was diagnosed in 51. Classic congenital hypopigmented patches were present in 42 and adenoma sebaceum occurred in 26 of the patients. Computed tomography (CT) is an essential diagnostic tool. We conclude that TS is more common than has been believed. Seizures are the most common manifestation of the disease and the hypopigmented patches, its first cutaneous manifestation, are present at an early age. When a positive diagnosis has been made, parents and siblings should be examined for signs of TS, keeping in the mind the wide spectrum of findings in this condition; if not stigmata are present on examination, then a CT scan should be considered for parents of reproductive age so that proper genetic counseling can be given.

Child↗
PubMed1981

The CT appearance of avulsion of the posterior vertebral apophysis. A case report.

Avulsion and posterior dislocation of the posterior dislocation of the posterior part of the vertebral apophysis is a rare condition, occurring mainly in adolescence. If the avulsed part is ossified it may be diagnosed with conventional X-rays including myelography. The present case shows that CT scan with sagittal reconstruction gives exact information of the nature of the lesion as well as its extension into the spinal canal, and that CT alone is sufficient for preoperative diagnosis.

Adolescent↗
PubMed1981

CT for trauma to the base of the skull and spine in children.

Five patients have been selected to demonstrate the diagnostic accuracy of CT in cases of traumatic damage to the base of the skull and spine in infants and children. Ct is superior to any other diagnostic radiological technique as bone and soft tissues are usually equally well demonstrated during one visit to the Radiology Department. Thus, CT is considered to be the primary investigative procedure of choice to evaluate trauma of the base of the skull and spine in infants and children.

Adolescent↗
PubMed1981

The prognostic value of computed tomography as an adjunct to assessment of the term infant with postasphyxial encephalopathy.

Prospective follow-up studies were done on 62 term infants who were treated as neonates for clinical evidence of postasphyxial encephalopathy. Computed tomographic studies were done during the first two weeks of life and repeated at six months of age. All children were followed a minimum of 18 months, at which time they underwent a psychometric and a neurologic evaluation. Major neurodevelopmental sequelae consisted of: hydrocephalus; spastic quadriplegia, hemiplegia, or diplegia; or a mean Bayley score less than 70. Major sequelae were present in 29 (47%) of the children: all were severely handicapped. Five other children scored between 70 and 85 on the Bayley test. Computed tomographic scans were highly predictive of status at 18 months. Eleven of the 15 with intraventricular or parenchymal hemorrhage were severely handicapped. Eighteen of 20 with extensive areas of hypodensity of the white and gray matter (neonatal CT) were abnormal at 18 months. All but two were severely handicapped. The results suggest that CT studies are very useful in the care of the asphyxiated term infant who has clinical signs of encephalopathy.

Asphyxia Neonatorum↗