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Biomedical subjects

F A Hoffer

Publications and source records attributed to F A Hoffer.

At least 73 records · Page 4Linked to original sources
PubMed1990

MR imaging of fractures of the growth plate.

In order to assess whether MR imaging could be used to evaluate posttraumatic abnormalities of the growth plate cartilage, 28 MR imaging examinations of 26 physeal fractures were performed from 4 days to 2 years after injury. Twelve patients were studied within 6 months of the fracture. MR imaging changed the Salter-Harris classification in six. Interruption of the growth plate detected on T2-weighted images was associated with subsequent growth anomaly in six of eight patients. Horizontal fracture of the physis without interruption was associated with growth disturbance in only one of four patients. Sixteen growth plates were studied beyond 6 months after injury. Twelve had physeal bars and abnormal growth. Of four patients without physeal abnormality on MR imaging, two had normal growth and two had mild deformity. Our results show that MR imaging defects abnormalities in the cartilage that are associated with subsequent growth disturbances and provides accurate mapping of physeal bridging and associated growth abnormalities that have already occurred.

Adolescent↗
PubMed1990

Estrogen deficiency in adolescents and young adults: impact on bone mineral content and effects of estrogen replacement therapy.

Because the long-term effects of estrogen replacement in adolescents with ovarian failure and hypothalamic amenorrhea have not been previously studied, we conducted a 2-year study of 35 patients to determine factors contributing to baseline bone density measures (bone density, bone mineral content, and bone width) and the response to estrogen therapy. Estrogen-deficient patients were often profoundly osteopenic by single-photon absorptiometry of the radius and dual-photon absorptiometry of the spine, despite estrogen replacement. Variables that were significant predictors of better initial single-photon absorptiometry measurements included increased age, increased body mass index, spontaneous pubertal development, lack of radiation therapy, and lower serum osteocalcin. Patients treated with estrogen/progestin had stable cortical bone mineral content and bone density at the distal one-third of the radius, a slight improvement in bone density at the distal one-tenth of the radius, and on encouraging, but marginal, improvement in the z score (standard deviation from the mean) of bone mineral content at the distal one-tenth. The z scores for cortical bone width and bone density decreased, suggesting a possible relative worsening over time. In untreated estrogen-deficient girls, bone mineral content and bone density decreased (but not significantly); the z score of cortical bone width showed a significant decrease. Using dual-photon absorptiometry, a history of radiation therapy was found to be a predictor of lower bone density compared with age-matched controls. Estrogen progestin therapy did not result in changes in serum levels of lipids and antithrombin III, weight, or blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1989

Metabolism of tumor regression from angiogenesis inhibition: 31P magnetic resonance spectroscopy.

31P NMR spectroscopy was used to analyzed the in vivo metabolism of reticulum cell sarcoma of mice. The ratio of high- to low-energy phosphates ATPB/(Pi + PME) was measured to reflect the relative metabolic state in the tumor. Of the 34 mice studied, 26 were treated with an antiangiogenesis regimen of heparin and cortisone. Eighty-two percent of the tumors treated eventually decreased in volume (P less than 0.01). Volumes and spectroscopic information of 20 tumors were analyzed. Although the average untreated volume was similar to the volume after 3 days of treatment, the average ATPB/(Pi + PME) ratio rose from 0.34 +/- 0.10 to 0.47 +/- 0.07 (P = 0.02). However, after 6 days of treatment, the volume significantly decreased (P less than 0.0001) but the ratio did not significantly rise further (P = 0.06). The rise in the high-energy phosphate preceded a significant decrease in volume of the tumors. In addition, the replenishment of high-energy stores with tumor regression coincided with the histologic findings of a decrease in the number of tumor cells, a decrease of the mitotic index, and a decrease of the number of necrotic cells present with ongoing treatment. Our data suggest that noninvasive methods of assessing early biochemical response of tumor regression may be possible.

Animals↗
PubMed1988

Peritoneal inclusion cysts: ovarian fluid in peritoneal adhesions.

In four women pelvic peritoneal inclusion cysts were diagnosed with ultrasound or computed tomography. Three patients had a history of multiple surgical procedures, whereas the fourth had prior severe abdominal trauma. Imaging studies showed large cystic structures contiguous with the adnexa. The normal ovarian appearance was distorted in two women. Pathologic confirmation was obtained in all cases. When large adnexal cystic structures are identified in young women with a history of surgery or trauma, the diagnosis of peritoneal inclusion cysts should be entertained. Recognition should result in conservative therapy rather than salpingo-oophorectomy.

Adolescent↗
PubMed1988

Infected bilomas and hepatic artery thrombosis in infant recipients of liver transplants. Interventional radiology and medical therapy as an alternative to retransplantation.

Fifteen children less than 12 kg in weight underwent transplantation of the liver for biliary atresia; eight survived. Five of the eight survivors had thrombosis of the hepatic artery without portal vein thrombosis. Three of the five patients with hepatic artery thrombosis developed infected bilomas, which were drained percutaneously under ultrasonographic (US) or computed tomographic (CT) guidance. Concurrent therapy with antibiotics and hyperoxygenation resulted in resolution of these intrahepatic collections. Although it had been thought that thrombosis of the hepatic artery most often results in necrosis of the graft and requires retransplantation, the five patients in this study survived without retransplantation. Diagnosis of hepatic artery thrombosis was achieved with the use of Doppler US in four cases, CT in four cases, and angiography in two cases. Duplex Doppler US is the preferred imaging modality.

Bile↗
PubMed1988

Cortical echogenicity in the hemolytic uremic syndrome: clinical correlation.

The initial renal sonograms of 15 patients, aged 8 months to 5 years, with hemolytic uremic syndrome (HUS) were reviewed. Ultrasound studies were graded according to cortical echogenicity relative to the liver, they were compared to the severity of the clinical syndrome at admission and to the ultimate outcome of the disease. The degree of cortical echogenicity correlated with the clinical outcome of HUS in 12 of the patients, whereas clinical assessment alone predicted outcome in 13 patients. Sonography overestimated severity in three patients with mild disease correctly assessed clinically, whereas clinical assessment overestimated severity in two patients with moderate disease in whom the sonographic assessment proved correct. The sonographic changes are most likely multifactorial. They appear to reflect a combination of platelet-thrombus deposition in the renal cortex, as well as the general fluid status of the patient. Ultrasound is useful in ruling out other causes of acute renal failure such as obstruction or congenital diseases. It cannot replace laboratory tests and clinical judgement, but nevertheless provides another index of severity in patients with HUS.

Child, Preschool↗
PubMed1987

Ilio-psoas abscess: diagnosis and management.

The triad of fever, limp, and pain in the flank, pelvis or leg often leads to the evaluation of the hip, genitourinary or gastrointestinal system. In the past 6 years, at our hospital, five adolescents and one young adult with these symptoms have had an ilio-psoas abscess, all diagnosed by ultrasonography. Once the diagnosis was established, four patients were treated successfully by percutaneous retroperitoneal drainage guided by ultrasonography or computed tomography. Catheter drainage averaged 11 days accompanied by appropriate antibiotics. The remaining two patients had surgical transperitoneal drainage. Growth of Staphylococcus aureus, from an ilio-psoas abscess indicates that the process is primary in origin. Growth of fecal flora suggests an intra-abdominal process and warrants further investigation. Ilio-psoas abscess can be readily diagnosed by ultrasonography or computed tomography and treated by percutaneous retroperitoneal drainage.

Abscess↗
PubMed1987

The treatment of post-operative and peptic esophageal strictures after esophageal atresia repair. A program including dilatation with balloon catheters.

Nine patients, 6 weeks to 17 years of age with esophageal atresia (EA), developed esophageal strictures and were treated with 26 balloon catheter dilatations over a period of 3 years; 6 are now asymptomatic. Five of the 9 patients had suspected reflux esophagitis, confirmed in 3 by biopsy and treated medically prior to dilatation. Seven of the 9 patients had a primary anastomosis, 1 a gastric tube, and 1 a colonic interposition. Most dilatations in the group of 7 were performed with balloon (B) greater than or equal to the diameter of the distal esophagus (E) (B/E greater than or equal to 1). The 3 residually symptomatic patients include an infant dilated conservatively (B/E less than 1) to facilitate later bouginage, 1 patient with a recurrent stricture after stopping medical therapy and home bouginage, and 1 infant who had a persistent anastomotic stricture, suspected but untreated reflux esophagitis, and a perforation during the second balloon dilatation. Balloon catheter esophageal dilatation, as an alternative to bouginage, is usually a safe and effective procedure when reflux esophagitis is diagnosed and treated prior to dilatation.

Adolescent↗
PubMed1986

Maintenance of vascular access patency in pediatrics.

The patency of vascular access shunts and fistulae has been prolonged by a combined surgical and radiological approach that includes percutaneous transluminal angioplasty (PTA), surgical revision, thrombectomy, and thrombolysis. Over the last 3 years, 35 vascular accesses in 27 patients were found to have angiographic abnormality. PTA was performed 32 times on 19 accesses and 7 PTAs resulted in patent accesses by the end of the study. Surgical revision was performed 9 times on 8 accesses and 2 of the surgical revisions resulted in a patent access by the end of the study. Concerning Thomas femoral shunts, PTA prolonged the patency by 2.2 months and surgical revision by 3.8 months per procedure. Concerning arteriovenous (AV) fistulae, PTA prolonged the patency by 4.3 months and surgical revision by 3.5 months per procedure. A combination of procedures effectively doubles the duration of patency of Thomas femoral shunts and almost triples the duration of patency of AV fistulae in children. Forty-one percent of these accesses remain open 1 year following the initiation of these procedures.

Adolescent↗
PubMed1985

Therapeutic catheter procedures in pediatrics.

There is a large spectrum of interventional catheter procedures being performed presently in children. The procedures that offer a greater advantage than surgical techniques and that will continue to be established procedures include percutaneous angioplasty of the pulmonary valve, peripheral pulmonary artery and caval stenosis, embolizations of pulmonary collaterals and pulmonary arteriovenous malformations, angioplasty of vascular access shunt, embolization of bronchial arteries for hemoptysis, and percutaneous nephrostomy and abscess drainage procedures. Others that have been successful but not yet routinely established in children include thrombolysis, renal artery angioplasty, embolization of peripheral arteriovenous malformations, dilatation of the urinary and gastrointestinal tract stenosis, and percutaneous biopsy.

Angioplasty, Balloon↗
PubMed1985

Intermittent hydronephrosis: a unique feature of ureteropelvic junction obstruction caused by a crossing renal vessel.

Obstruction at the ureteropelvic junction (UPJ) is usually intrinsic. Recently, however, 13 (11%) of approximately 120 children with UPJ obstruction were found to have extrinsic obstruction caused by a lower-pole renal vessel. In each case, the obstruction was confirmed at the time of surgery. Most of these patients had intermittent pain. Excretory urograms did not show obstruction between episodes of pain, but when a urogram was obtained during an episode, marked obstruction was noted. Contrast agent trapped in a segment of proximal ureter suggests the presence of an extrinsic obstruction. Properly timed renal imaging, therefore, can identify the urinary tract as the source of the symptoms.

Adolescent↗
PubMed1985

The interrenicular junction: a mimic of renal scarring on normal pediatric sonograms.

A triangular, echogenic focus of perirenal tissue in the anterosuperior or posteroinferior margin of the kidney, the junctional parenchymal defect (JPD), and an oblique echogenic line, the interrenicular septum (IRS), connecting the JPD to the renal hilum are normal sonographic findings in the pediatric age group. They are manifestations of an oblique interface between the two parts (reniculi) of one kidney. They should not be mistaken for renal scars. Prospectively, in a group of 100 children, either the JPD or IRS was seen in 46% of right kidneys and 19% of left kidneys. Retrospectively, the JPD was seen in 47% of right kidneys and 18% of left kidneys, and the IRS was seen in 39% of right kidneys and 12% of left kidneys.

Adolescent↗
PubMed1984

The cross-table lateral view in neonatal pneumothorax.

The cross-table lateral view of the chest can facilitate a more realistic appreciation of a pneumothorax than the supine frontal projection alone or in combination with the vertical-beam lateral view. This view also permits an optimal evaluation of the relative position of the lung, intrapleural air, and the tip of the chest tube in the supine newborn. The presence and size of a pneumothorax can usually be determined by locating the anterior lung edge on the cross-table lateral view. The anteroinferior corner of lung often aids in locating this anterior lung edge. The other structures that simulate the anterior lung edge on the cross-table lateral view include sternal retraction, rib ends, the axillary soft-tissue density, and posterior atelectasis. Because of the cause-effect relation of pneumothorax to intracranial bleeding in the premature infant, more widespread use of this technique to detect pneumothorax is recommended.

Humans↗
PubMed1983

Z-shaped duodenojejunal loop: sign of mesenteric fixation anomaly and congenital bands.

Four children (ages 3-9 years) with intermittent abdominal pain and vomiting are reported. Upper gastrointestinal examinations revealed a sharply angulated to-and-fro course (Z configuration) of the distal duodenum and proximal jejunum, rather than the usual smooth duodenojejunal loop at the ligament of Treitz. At operation this configuration was associated with broad peritoneal bands extending across the involved small intestine without an accompanying volvulus at this level. The Z sign is diagnostic of incomplete rotation, even in the absence of duodenal obstruction and with a proximal jejunum that may appear to be properly placed.

Child↗
PubMed1979

The "In-Training Examination" of the American Board of Pediatrics: does it test for "new" or "old" information?

The American Board of Pediatrics In-Training Examination or "Pre-Test" is not in widespread use as a means of evaluating the cognitive knowledge and problem-solving skills of hourse officers. The examination is modeled after the certifying examination of the American Board of Pediatrics. The 1977 Pre-Test was analyzed in an attempt to determine whether awareness of recent medical knowledge was required to pass this examination. The 7th through 10th editions of the Nelson Textbook of Pediatrics were used as a reference source. These editions represent information that is from 5 to at least 20 years of age. Analysis of the 190 items revealed that the correct answer was known for 148 or 78% of the questions at least 20 years ago. These results suggest that the Pre-Test, and presumably the American Board of Pediatrics certifying exam, measures the candidates' knowledge of long-standing core information.

Educational Measurement↗
PubMedDate not supplied

Percutaneous biopsy of thoracic lesions in children.

Over the last 6 years, 15 percutaneous thoracic biopsies have been performed in 15 children. The peripheral nature of most of the lesions allowed ultrasound guidance in ten and needles larger than 21 gauge in ten. No pneumothorax developed. Of the 15, 12 biopsies were sufficient for final diagnosis; 3 required surgical biopsy for more definitive tissue typing.

Adolescent↗