Biomedical subjects
Publications and source records attributed to H B Patriquin.
A prospective study of abdominal and chest films of 212 babies without symptoms of intra-abdominal disease, aged 1 day-12 weeks, showed that the bubbly "fecal pattern" normally seen in older children is rare in young premature babies in the first two weeks of life. When it is seen, it may represent intramural air bubbles and signal the presence of necrotizing enterocolitis.
A review of 793 consecutive abdominal sonograms in children aged 1 day to 16 years disclosed 453 patients in whom the gallbladder was clearly visible on at least two perpendicular views. Twenty had a gallbladder wall more than 3 mm thick. The following diseases were associated with gallbladder wall thickening; hypoalbuminemia (13 cases), ascites (five, three with concomitant hypoalbuminemia), physiologic thickening because of partial wall contraction (one), and systemic venous hypertension (one). None of 26 patients with gallstones and one of 14 with sludge had a thickened gallbladder. (The latter patient had concomitant hypoalbuminemia). Five patients with surgically proven acute cholecystitis during this same interval of time had sonograms. In four, the gallbladder wall was of normal thickness. In the fifth patient, the gallbladder wall could not be visualized because of densely shadowing stones. In this population, thickening of the gallbladder wall was not associated with acute cholecystitis and thus was not an indication for cholecystectomy.
A mass adjacent to the right upper mediastinum in an asymptomatic seven-week-old girl displacing the upper lobe segmental bronchi was considered to be a normal thymus. The mass regressed over the next two years. The child is clinically and radiologically normal at age seven years.
A retrospective study of 140 babies who survived the first week of life and who had endotracheal intubation showed that 65 of them had either or both of the following complications of endotracheal tube therapy: (a) Collapse of one or more lobes with the tube in place or within the first two days following extubation and lasting less than 24 hours. When collapse lasted more than 48 hours, it often required repeated intubation for tracheal cleansing. The right lung, especially its upper lobe, was predominantly affected. (b) Tracheal lesions and nasal necrosis. A statistical comparison with intubated babies of similar age without complications showed the following factors to predispose to lobar collapse: younger gestational age, maximal high oxygen concentration administered, and prolonged duration of intubation. The results of endotracheal tube cultures bore no relation to the complication rate.
Multiple, irregular ball-and-socket deformities at the ends of long bones were noted in four children several years after they had had meningococcemia. Even though these lesions were clinically unsuspected at the time of the fulminant disease, they were probably the result of ischemia secondary to septic emboli to the epiphyseal vessels, which occurred at the same time as soft-tissue necrosis elsewhere. The individual lesions were radiologically identical to the metaphyseal cupping that has been reported following trauma to the growth plate.
Twelve cases of neonatal intussusception are presented and another 25 taken from the literature are reviewed. Intussusception in the first month of life is a distinct clinical and pathological entity, presenting as bowel obstruction in the first days and usually led by a tumor. In the past, a high mortality rate has been related to late diagnosis. The barium-enema examination is diagnostic.
Three unrelated southern Italian children manifested I-cell within the first month of life, but it was not recognized initially. Radiologic findings of osteopenia, subperiosteal new bone formation and resorption, and irregular metaphyses suggested systemic bone disease. Premature suture synostosis was evident at age 2-4 weeks. Review of the literature and experience with these cases establish these findings as valuable and specific clue to the diagnosis of I-cell disease. By 6-10 months of age, the clinical and radiologic features were similar to those in Hurler syndrome. Cardiorespiratory death occurred in two cases.
The authors review the anatomy of the pleural reflection of the right lung against the middle mediastinum in childhood. In 505 consecutive normal frontal radiographs of children, from birth to sixteen years, this pleural reflection (also known as the pleuro-esophageal line) was visible in 83%. The entire reflection from thoracic inlet to diaphragm was clearly seen in 13%, chiefly in upright, deep-inspiration, well penetrated radiographs. It is a radiographic landmark in the middle mediastinum, particularly well seen in childhood, and its use in assessment of mass lesions, cardiomegaly and lung collapse is described.
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Adenoid hypertrophy has several variable symptoms. In this study, symptoms were divided into minor and major. A lateral radiograph of the nasopharynx was performed in 114 patients to study the superior and antroadenoid diameters. With proper statistical analysis, a correlation was made between the various clinical groups (scores) and the adenoid measurements. Our results support Hibbert's findings that the antroadenoid width is a better indicator of the symptom-producing adenoid than adenoid mass measurements with their loosely defined norms. A thorough history and physical examination remain paramount in the diagnosis and management of adenoid hypertrophy.