Biomedical subjects
Publications and source records attributed to J F Johnson.
A baby with two lower cervical tracheoesophageal fistulas was evaluated with a barium esophagram and computerized tomography (CT). The esophagram identified both fistulas. Axial CT demonstrated the esophageal attachment of the upper fistula and completely displayed the lower fistula. A change in caliber of the esophagus from a collapsed to a distended state marked the site of the fistulas.
The osteolysis associated with cat-scratch fever resembles more ominous conditions. The combination of osteolysis and unilateral regional adenopathy in a child or adolescent should suggest cat-scratch disease.
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Three forms of peripheral right upper lobe collapse are described. One form has a straight or slightly concave medial border that mimicks pleural fluid. A second variety protrudes from the inferior lateral aspects of the atelectatic right upper lobe producing a triangular opacity that tapers inferiorly toward the chest wall. A third variety produces a convex medial interface with the lung that simulates an extrapleural mass or loculated fluid.
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Neonatal abdominal plain films were prospectively analyzed over a 41-month period in order to generate a differential diagnosis for focal bowel distension during the first 6 weeks of life. A total of 31 examples of locally distended bowel were collected. The study discredits the concept that asymmetrically distended bowel in the newborn is usually caused by necrotizing enterocolitis (only 9/31 cases) and indicates that distended bowel in the lower abdomen or left upper quadrant is often caused by air trapping in normal but redundant rectosigmoid (11 cases) or in distal transverse colon (three cases). Five other pathologic conditions not normally specified in differential diagnoses of focally distended bowel included inguinal hernia (three cases), small bowel atresia (two cases), midgut volvulus (one case), Hirschsprung's disease (one case), and small left colon (one case). The study emphasizes the value of sequential supine and prone filming for distinguishing normal from pathologic dilated loops of bowel.
Expansion of consolidated lung by positive pressure facilitates identification of a pleural parenchymal interface in the baby with an opaque hemithorax.
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A review of the records and radiographs of 21 newborn infants with necrotizing enterocolitis and 10 control infants was performed to test the significance of the persistent loop sign in necrotizing enterocolitis. Twelve clinical and laboratory variables were compared with the persistent loop sign. None of the control infants and seven of the 21 study infants had a persistent loop sign. Four of the seven infants were proven to have necrotic bowel. All four died. Four of the 14 study patients without the persistent loop sign had necrotic bowel. Two of these four infants died. The findings of this study do not support the use of a persistent segmental loop of bowel as a single criterion for surgical intervention.
The chest radiographs of 10 babies who developed an abrupt diffuse pulmonary parenchymal opacification in conjunction with pulmonary hemorrhage, pulmonary edema, or pneumonia as a complication of hyaline membrane disease were reviewed. The chest radiographs of these 10 babies were compared to five radiographs obtained with various degrees of expiration in four babies with uncomplicated hyaline membrane disease. The comparison indicates that analysis of air bronchograms facilitates discrimination of pulmonary opacification due to filming in expiration from pathologic diffuse parenchymal opacification in babies with hyaline membrane disease. Expiration produces constriction and centralization of air bronchograms. Alveolar filling processes are associated with distension and peripheral extension of air bronchograms.
To determine the incidence and distribution of dorsal defect of the patella, the radiographs of 2,349 knees in 1,192 consecutive patients were evaluated. The defect was present in about 1% of the population. It may be found at any age from the preadolescent to the mature adult. Females were more commonly affected than males. The test population group was validated by concurrent tabulation and comparison with other series of two other bening lesions occurring at the knee: fabella and multipartite patella.
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Pneumocystis carinii pneumonia is a devastating disease state that is almost always fatal without appropriate therapy. The offending organism is difficult to culture, and the diagnosis is best confirmed by performing an open-lung biopsy. Drug therapy includes pentamidine in doses of 4 mg/kg/d im and/or trimethoprim/sulfamethoxazole (TMP/SMX) in doses of 20 mg/Kg/d of the former and 100 mg/kg/d of the latter in four divided doses. Of these two agents, TMP/SMX appears to be most effective, although pentamidine may be of benefit if the combination product fails. Adverse effects associated with pentamidine are greater in number and more severe than those associated with TMP/SMX. A case report is presented to demonstrate drug therapy and the severity of the disease.
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