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Biomedical subjects

D F Merten

Publications and source records attributed to D F Merten.

At least 37 records · Page 2Linked to original sources
PubMed1986

Diagnostic imaging in pediatrics: the state of the art.

The results of the study panels, both at national and international levels, have shown that much can be done to increase the efficiency and efficacy of diagnostic imaging in all areas of medical practice including pediatrics. Much remains to be done, however. The work that has been done must be expanded into a thorough investigation of the safety, yield, and cost of diagnostic imaging. It is the responsibility of all physicians to continue efforts toward more rational use of diagnostic imaging at all levels of society and to make sure that established guidelines are implemented. Flexibility in attitudes, cooperation between clinician and radiologist, and a willingness to learn and keep up with advances are essential to this process--not only to improve the benefits from diagnostic imaging, but to preserve the ability of society to pay for it. Those who would proclaim that this or that recommendation is the "last word" must realize that half of what is said today may well be proven false 10 years from now, and, further that we have no way of knowing what techniques and imaging approaches will comprise that half, nor should the imaging "standards" be self-serving. Guidelines drawn up in an academic vacuum where all imaging techniques are readily available may have little practical application in pediatric practice and impact on health care in areas of the world where diagnostic imaging, if available at all, will consist only of basic radiographic imaging. At the same time, experience gained in countries using all advanced imaging modalities must be shared with less fortunate nations: such knowledge may have important implications for even the most basic radiographic studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1985

Pneumomediastinum: an unusual complication of acute gastrointestinal disease.

Atraumatic or primary pneumomediastinum is an uncommon complication of severe retching and vomiting associated with acute gastrointestinal disorders. In two cases pneumomediastinum was the presenting radiographic abnormality; one patient presented with acute gastroenteritis, and the other presented with duodenal obstruction due to hematoma. The pathogenesis of pneumomediastinum in these patients is presented.

Acute Disease↗
PubMed1985

Diagnostic imaging of pediatric abdominal masses.

This overview delineates the clinical and pathological features of various abdominal mass lesions found in neonates and in older infants and children. The application and limitations of imaging procedures currently available are reviewed with emphasis on the principles and advantages of advanced imaging techniques. Selected pediatric abdominal masses are discussed and their radiologic features illustrated. Integrated imaging strategies for abdominal masses in the newborn and in the older infant and child are proposed.

Abdominal Neoplasms↗
PubMed1985

Large opaque hemithorax due to cardiomegaly and atelectasis.

We studied the clinical and radiologic features of five infants with a large opaque left hemithorax due to the combination of cardiomegaly and atelectasis. The causes of cardiomegaly were cardiomyopathy (two patients), congestive heart failure due to fluid overload, congenital mitral insufficiency, and idiopathic hypertrophic subaortic stenosis. In all five patients, there was initial total opacity of the left hemithorax with shift of the heart and mediastinum to the right due to the combination of cardiac enlargement and total lung collapse. The correct diagnosis may be suggested from conventional chest roentgenograms. Noninvasive supplementary studies, such as high-kilovolt roentgenography, fluoroscopy, esophagography, echocardiography, and radionuclide angiography, should be done for clarification.

Aortic Stenosis, Subvalvular↗
PubMed1985

Adult respiratory distress syndrome in children.

Clinical, radiological, and pathologic data for nine children with adult respiratory distress syndrome (ARDS) were reviewed. The children ranged in age from 7 months to 15 years (mean age, 7.4 yrs). Underlying diseases and precipitating events included sepsis, pneumonia, near drowning, aspiration pneumonia, central nervous system trauma, and malignancy. All patients had the rapid onset of diffuse bilateral lung opacification, required assisted ventilation for periods of 5-86 days (mean, 25.2 days), and received high levels of inspired oxygen for 2-41 days (mean, 12.7 days). Eight patients manifested air leak complications; these problems persisted until the patients died or were weaned from the respirator. Five of the nine patients died. Autopsy in three patients demonstrated alveolar duct fibrosis characteristic of the late proliferative phase of ARDS and consistent with oxygen toxicity. Two survivors demonstrated mild restrictive changes on follow-up pulmonary function tests and showed persistent linear densities on chest radiographs.

Central Nervous System↗
PubMed1984

The Currarino triad: complex of anorectal malformation, sacral bony abnormality, and presacral mass.

The Currarino triad is a unique complex of congenital caudal anomalies including anorectal malformation, sacral bony abnormality, and presacral mass. The usual symptomatology is constipation due to anorectal stenosis. Contrast enema and computed tomographic myelography are the imaging modalities of choice for diagnostic confirmation and clarification of the anomalies. The clinical features, unique radiologic appearance, and importance of a correct diagnosis of the Currarino triad are reviewed.

Abnormalities, Multiple↗
PubMed1984

Craniocerebral trauma in the child abuse syndrome: radiological observations.

Experience with craniocerebral trauma in 712 physically abused children is reviewed. Ninety-three (13%) had evidence of head trauma (cranial and/or intracranial). Seventy-seven of these patients had computed tomography (CT) of the head, and 47 had CT evidence of intracranial injury. Extracerebral fluid collections, predominantly convexity subdural hemorrhage, were the most common acute intracranial lesions. Concurrent intracranial and skeletal trauma (cranial and/or extracranial) was present in 33 of the 47 patients (70%) with intracranial injury. A high incidence of skull fractures (45%) in those children with intracranial lesions suggest a significant role for impact head injuries ("battering") in the pathogenesis of craniocerebral trauma in the child abuse syndrome. Greater emphasis on CT examination in evaluation of the abuse infant and child is recommended.

Acute Disease↗
PubMed1984

Pulmonary blastomycosis: radiologic manifestations.

Blastomycosis, an airborne fungal disease with the lung the portal of entry, is endemic to the central and south central areas of the United States. The disease occurs in patients who range from asymptomatic to those with symptoms of acute pneumonia. Retrospective review of 27 cases from our institution revealed four well-defined radiographic patterns including air-space disease, nodular masses, interstitial disease, and cavitation. Some patients with air-space disease have symptoms of an acute pneumonia; more commonly they have no pulmonary symptoms. Air-space disease was the most frequent radiographic pattern in chronic blastomycosis with proved nonpulmonary disease; therefore, it cannot be regarded as indicative of early or acute blastomycosis. There was no relationship between the radiographic pattern and distribution, pulmonary symptomatology, or clinical stage of the disease. Our material does not support the previously suggested association of lower lobe air-space disease with early disease and upper lobe involvement with the chronic and often disseminated form. A more precise understanding of the variety of radiographic patterns and the spectrum of clinical presentations will facilitate diagnosis of pulmonary blastomycosis.

Adolescent↗
PubMed1984

An imaging approach to persistent neonatal jaundice.

Fifteen patients with persistent neonatal jaundice were evaluated by sonography and radionuclide scintigraphy. The sonographic features of both neonatal hepatitis and biliary atresia are nonspecific. Hepatobiliary scintigraphy after phenobarbital pretreatment in patients with neonatal hepatitis demonstrates normal hepatic extraction and delayed tracer excretion into the gastrointestinal tract. If there is neonatal hepatitis with severe hepatocellular damage, the hepatic extraction of tracer activity is decreased and excretion may be delayed or absent. Patients under 3 months of age with biliary atresia have normal hepatic extraction of tracer with no excretion into the gastrointestinal tract. Sonography in patients with a choledochal cyst shows a cystic mass in the porta hepatis with associated bile-duct dilatation. Hepatobiliary scintigraphy confirms that the choledochal cyst communicates with the biliary system. Initial sonography demonstrates hepatobiliary anatomy; subsequent phenobarbital-enhanced radionuclide scintigraphy determines hepatobiliary function. An expedient diagnostic approach is recommended for the evaluation of persistent neonatal jaundice.

Bile Ducts↗
PubMed1983

Localized pulmonary interstitial emphysema: treatment by bronchial occlusion.

Selective bronchial occlusion for the treatment of localized cystic pulmonary interstitial emphysema (PIE) offers a means to facilitate weaning from ventilatory support and to preserve potentially functional lung parenchyma. We employed a commercially manufactured balloon catheter, placed under direct visualization to occlude a left mainstem bronchus in two cases of localized PIE. This is the safest method for selective bronchial occlusion so far reported. Therapeutic success was achieved with either continuous or intermittent bronchial occlusion. Evaluation of pulmonary function with nuclear scintigraphy aids in determining the most appropriate position for the occluding catheter and permits assessment of the resultant improvements in pulmonary function.

Bronchi↗
PubMed1983

The abused child: a radiological reappraisal.

Radiological findings in 563 abused infants and children who were studied retrospectively emphasize the limitations of diagnostic imaging, specifically radiographic examination of the skeleton. Skeletal trauma was detected in less than one-third of all patients and was uncommon beyond two years of age. Fractures were rarely present without clinical evidence of physical abuse. Radiographic features considered specific for child abuse (epiphyseal-metaphyseal, rib fractures) or highly suggestive (occult, multiple/repetitive fractures) were distinctly infrequent and limited to infancy. A more efficacious approach to radiological evaluation based on clinical presentation is offered.

Adolescent↗
PubMed1983

Craniocerebral trauma in the child abuse syndrome.

Craniocerebral trauma, and more specifically intracranial injury, is the most devastating consequence of child abuse. Cranial computed tomography provides a sensitive method for evaluation of the abused child for craniocerebral injury. CT may be particularly useful for demonstrating intracranial lesions that might not be immediately evident from clinical examination. The CT findings may also clarify the nature of the trauma, both cranial and intracranial, with detail not otherwise possible. It is therefore surprising that an expanded role for CT in evaluation of child abuse has not received wider general consideration or acceptance. Discussions of child abuse either fail to note CT in evaluation of the abused child or give the subject only cursory attention. Caffey's initial admonition that the presence of unexplained fractures in the long bones warrants investigation for subdural hematoma has gone largely unheeded. A high index of suspicion for abuse, especially in the young infant, should be sufficient reason to request cranial CT. In some cases of abuse without acute neurologic abnormality chronic sequelae, otherwise unsuspected, may be demonstrated by follow-up CT.

Battered Child Syndrome↗