Biomedical subjects
Publications and source records attributed to H Grossman.
The rational selection of imaging modalities for the diagnosis of renal and adrenal masses in children is discussed with a view toward obtaining an accurate assessment of pathologic changes with the least amount of stress and expense to the patient. The integration of the results of these tests in specific clinical settings is also described.
Chronic depletion of body chloride developed in a group of infants ingesting a diet consisting almost exclusively of chloride deficient Neo-Mull-Soy. Ten of the 12 infants were on this diet three to five months before loss of appetite, failure to thrive, muscle weakness, and lethargy led to a diagnostic evaluation. The outstanding laboratory features were severe hypokalemic metabolic alkalosis, low urinary chloride concentrations (< 10 mEq/liter), and erythrocyturia. There was marked decrease in weight for age in all 12 infants. Head circumference for age had decreased in five of six and length for age in five of ten infants for whom earlier measurements were available. The biochemical abnormalities reverted to normal following dietary supplementation with either sodium or potassium chloride. Appetite, affect, and muscle strength improved, and weight gain resumed. Head circumference for age has moved toward the percentile level present prior to starting Neo-Mull-Soy in all instances. With one exception, length measurements show a similar pattern. The erythrocyturia has decreased or vanished. Chloride deficiency led to contraction of the extracellular volume and the substitution of poorly reabsorbable anions for readily reabsorbable chloride. These alterations caused development of the negative hydrogen ion and potassium balances which led to the hypokalemic metabolic alkalosis.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Roentgenographic and clinical findings in a spectrum of malformations of the trachea and oesophagus are discussed. Five previously unreported patients representing four rare anomalies of tracheal agenesis, laryngotracheo-oesophageal cleft, oesophageal atresia with a tracheo-oesophageal (T-E) fistula to the proximal oesophageal pouch, and T-E fistula without oesophageal atresia (H-type fistula) are presented. These anomalies can be characterised by a failure in separation of the oesophagus and trachea and by atresia of either organ. All of the patients were diagnosed roentgenographically. Since the incidence of associated abnormalities is high in babies with these anomalies, a generalised embryological defect must be a basic assumption in any theory to explain the development of T-E anomalies.
Susceptibility to recurrent staphylococcal cutaneous and respiratory infections beginning in infancy associated with extreme hyperimmunoglobulinemia E is a recently described primary immunodeficiency syndrome. Other clinical features include depressed cellular immunity and deficient antibody formation. Recurrent pneumonia and cyst formation with variable persistence and expansion characterized the radiographic couse in 11 patients. Five cysts resolved with continuous antistaphylococcal therapy; 2 were resected without recurrence; and 4 persisted after surgery and/or antibiotics (2--8 years). The cysts had dense, necrotic surfaces with fibrous walls, eosinophilic and other inflammatory cell infiltrates, and frequent, persistent, bronchial connections. Sinusitis (9/9) and mastoiditis (3/4) were also observed radiographically.
Two patients with the prune belly syndrome demonstrated colon calcifications and anorectal malformations. Bladder outlet obstruction was present in both cases. Calcifications were also found in the renal collecting system and bladder of one patient. No fistula was demonstrated between the genitourinary tract and bowel in either infant at autopsy. The calcification in the colon and urinary tract is probably secondary to stasis.
Two neonates with uriniferous perirenal pseudocysts (urinomas) secondary to posterior urethral valves are presented. Early diagnosis was achieved and both patients survived. The characteristic roentgenographic appearance of the pseudocyst is described. An investigation for lower urinary tract obstruction should always be undertaken when pseudocyst or ascites is seen in the neonate. Prompt diagnosis and treatment is essential to avoid irreversible renal damage, electrolyte or fluid imbalance, or respiratory compromise.
The actions of fully co-ordinated, inert nickel(II) chelates of 1,10-phenanthroline and 3,4,7,8-tetramethyl-1,10-phenanthroline have been compared on the guinea-pig isolated atrium with those of their constituent metal ion and ligands. In general, each test substance showed distinctive actions suggesting that the effects of the metal chelates are mediated by the intact chelate cation and not by liberated metal ion or ligand. Differences in the actions of the unsubstituted and the highly methylated compounds may result from the greater capacity of the methylated chelate and ligand to induce more profound and sustained conformational changes in the responsive atrial pre- and postsynaptic membranes thereby promoting more rapid and prolonged influx of Ca2+.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Two cases of vertebral sarcoidosis in pediatric patients are presented. All such patients reported have been black, 13-15 years old, and have a history of back pain. Radiographs of the involved vertebrae show primarily lytic destruction with sclerotic borders in some of the lesions. Fungal infections, tuberculosis, pyogenic osteomyelitis, Hodgkin's disease and metastatic disease must be considered in every patient with vertebral sarcoidosis.
Four children ranging in age from 2 1/2 months to 4 years had excretory urography initially for reasons other than evaluation of an abdominal mass. Three patients had repeat urography only after masses became apparent at intervals of 8.5 months, 9 months and 15 months after the initial urogram. The fourth patient was followed with interval excretory urography for urinary tract infection and a large renal mass was seen 13 months after the initial urogram. The results suggest that the present data on estimated rates of growth do not support the established theory of the rate of growth for Wilms' tumor.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Intravenous urography with total body opacification, and tomography as required, often give the most information toward evaluating abdominal masses in children. Ultrasonography is a noninvasive procedure which defines normal structures and differentiates cystic and solid tumors. The combination of these studies gives sufficient information about renal tumors to plan for possible surgery. Arteriography is not necessary for the diagnosis of Wilms' tumor, nor its surgical or medical management. Pseudotumor of the kidney is due to focal cortical hyperplasia. It can be diagnosed by nephrotomography, renal arteriography or renal scanning. The latter method is most accurate and has the lowest morbidity. Aortography is advisable in the evaluation of a patient with pheochromocytoma in an attempt to locate multiple tumors. Determining the extent of abdominal neuroblastoma by angiography and lymphangiography does not appear to influence the mode of therapy, not the survival rate; therefore, invasive diagnostic procedures do not appear to be indicated in neuroblastoma. Angiography is necessary in the evaluation of liver cancer. If one lobe is determined to be free of disease, lobectomy is a possible cure. Splenic cysts and choledochal cysts can be diagnosed by noninvasive methods such as ultrasonography or radioisotope scanning. Arteriography and percutaneous opacification are not necessary to make these diagnoses.