Biomedical subjects
Publications and source records attributed to J J Seibert.
Indium-111 leukocyte scanning is a reliable means of locating acute infection in adults, but its use in the pediatric population has not been extensively documented. The results of scans on 30 children retrospectively reviewed are presented. Acute infections were detected in 15 of 16 patients (94% sensitivity) with one false negative scan. There were 8 truly negative and 6 falsely positive studies (57% specificity).
A bronchial foreign body should be strongly suspected in a child with an opaque chest without a previous history of airways disease when there is: any sign of volume loss or atelectasis in the lung density and bronchiectasis within the lung density. Ultrasound may be helpful to rule out the presence of pleural fluid and may even demonstrate the bronchiectasis when the bronchi are fluid-filled.
Our patient had DISIDA scan at 39 days of age to exclude biliary atresia. Gut excretion was seen 18 h after injection and the diagnosis of neonatal hepatitis was made. Because of continued elevated liver function values, liver biopsy was performed and demonstrated findings consistent with biliary atresia. Exploratory laparotomy performed 8 days after the scan showed patent cystic duct, bile duct, and gallbladder, but an atretic common hepatic duct. This case is an example of documented biliary atresia demonstrating gut excretion on the DISIDA scan.
Ultrasound has proved to be an effective means of monitoring umbilical artery catheters in the neonate for clot formation. Once a large clot has formed, it usually takes several weeks to months before it completely disappears. This is a report of a large clot that spontaneously resolved in ten days.
The nonoperative diagnosis of necrotizing enterocolitis (NEC) is dependent upon the radiographic finding of pneumatosis intestinalis. A significant number of neonates develop clinical signs compatible with NEC but nondiagnostic radiographs. This can result in delayed, inappropriate, or unnecessary therapy. This paper presents experience with portal vein (PV) ultrasonography in the diagnosis of NEC. Since January 1984, 15 newborns with suspected NEC have undergone PV ultrasonography (mean gestation 33 weeks, mean weight 1,705 g). Each had developed abdominal distention with evidence of sepsis. Stool was positive for occult blood in 11. Abdominal radiographs were interpreted as abnormal but nonspecific in 10 neonates, definite pneumatosis in 3, and normal in 2. No infant had portal vein air on plain abdominal radiograph. Occult PV air was detected by ultrasonography in five infants. These included all infants with obvious pneumatosis, a newborn with a nonspecific radiograph and a neonate with a "normal" x-ray. Of the ten infants without PV air on ultrasound, clinical symptoms resolved without specific therapy in seven. Two infants were proven to have nonenteric sepsis, and the remaining newborn developed intestinal necrosis secondary to aortic thrombus. In the five infants with occult PV air on ultrasound, two subsequently required intestinal resection. The remaining three were treated medically for ten days without sequelae. PV ultrasonography has proven to be a helpful adjunct in the early diagnosis of NEC. This diagnostic maneuver, when applied appropriately, may enable early therapy of the infant with NEC and avoid inappropriate or unnecessary therapy in the suspected case.
An asymptomatic thyroid nodule that appeared cystic on ultrasound was seen in a 14-year-old girl. Tc-99m pertechnetate thyroid imaging was expected to show a cold nodule, but surprisingly revealed a hyperfunctioning nodule. A partial thyroidectomy revealed an hemorrhagic cystic adenoma. The occurrence of a cystic nodule, which continued to show hyperfunction, is unusual.
Urinary ascites may be the most common cause of ascites in the neonate, and should be suspected in an infant with abdominal distention, oliguria, hyponatremia, and hyperkalemia. The diagnosis is confirmed when analysis of the peritoneal fluid shows creatinine, urea, and potassium concentrations higher than corresponding serum concentrations. The establishment of adequate urinary drainage by catheterization of the bladder or nephrostomy rapidly corrects electrolyte abnormalities.
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Ultrasonography has proven to be a helpful imaging modality in evaluating the child with a distended gasless abdomen. The presence of an unsuspected mass can easily be detected as well as the presence of ascites and/or abnormally dilated loops of small bowel. Thickened loops of bowel can also be easily detected in the abdomen with very little gas. Closed loop obstruction and intussusception, as well as meconium ileus equivalent (distal intestinal obstruction syndrome), are described.
There have been only nine cases of primary bronchopulmonary leiomyosarcoma (PBPL) in children reported in the English language literature, to our knowledge. Herein, we report the tenth case of PBPL in a 24-hour-old newborn infant with associated nonimmunologic hydrops fetalis. We believe this to be the youngest patient ever reported to have PBPL, and the first such tumor, to our knowledge, to be a possible cause of nonimmunologic hydrops fetalis. The patient was alive and well 34 months after a right-sided lower lobectomy, without the need for radiotherapy and/or chemotherapy. We review the clinical pathologic features, treatment, and follow-up of PBPL.
A hard, fixed mass on the chest wall is usually considered to be malignant. Of 24 such lesions we have evaluated in children, only eight (33%) were malignant. Six of the eight children with malignant masses died of the disease. Benign lesions were often indistinguishable from malignant lesions by physical or roentgenographic examination, and histologic diagnosis was often difficult. Small lesions could be excised en bloc without significant deformity. Seven masses were the product of indolent infection, indicating that cultures should be obtained. Larger lesions should have adequate biopsy to direct the proper sequence of subsequent radical operation, irradiation, and chemotherapy. The defect created by radical operation is closed with polypropylene mesh and/or flap coverage. With this graded approach, the majority of children with chest wall lesions will survive with minimal deformity.
Utilizing the sequence of contrast radiography, gastric technetium scintigraphy, and 24-hour pH probe, 30 of 46 (65%) neurologically impaired patients, referred for feeding gastrostomy, were demonstrated to have gastroesophageal reflux and underwent a Nissen fundoplication and gastrostomy. There was no evidence of reflux in the remaining 16 (35%) and a gastrostomy alone was performed. Four infants (aged 2 to 13 months) subsequently developed progressive vomiting from 2 to 8 months following gastrostomy placement. Repeat evaluation documented postoperative reflux in three. All four underwent a Nissen fundoplication with relief of their symptoms. Gastroesophageal reflux following gastrostomy may have been produced by an alteration in anatomy or progressive neurologic dysfunction. In all likelihood, however, it was present but undetected preoperatively. An antireflux procedure was required following gastrostomy in 25% of neurologically impaired patients with an initial negative reflux evaluation. Additionally, primary fundoplication in this group was associated with 10% incidence of recurrent symptoms. The high incidence of postoperative reflux, as well as the morbidity associated with gastrostomy in face of gastroesophageal reflux, warrants careful follow-up of the brain damaged patient with feeding gastrostomy.
Selective intubation of the left mainstem bronchus was accomplished successfully to treat a large pseudocyst of interstitial air in the right lung of an 890-g premature infant. The tube was left in place for 30 hours. Without the use of cutaneous oxygen monitoring to constantly evaluate the oxygenation of the baby and consequently, the correct position of the tube, this probably could not have been accomplished in such a small infant.
Excretory urography and cystography were done in 200 girls from less than 1 year to 14 years old with a history of urinary tract infections. In 147 girls (73.5 per cent) the excretory urogram and cystogram were normal. Reflux was demonstrated on voiding cystourethrography in 19.5 per cent of the patients. Only 3 patients were found to have a normal voiding cystourethrogram and a significant abnormal excretory urogram. In only 1 patient (0.5 per cent) was an abnormality (an ectopic obstructed ureter) identified, which was amenable to intervention. We conclude that in the evaluation of girls with urinary tract infection an excretory urogram is indicated only in the presence of vesicoureteral reflux.
We report a case of the megacystis-microcolon-intestinal hypoperistalsis syndrome and review the literature. Generally, this disease affects female neonates and is usually fatal within the first year of life. All patients have microcolon megacystis, intestinal hypoperistalsis, abdominal distention and dilated small bowel. Although the dilated bowel and urinary tract suggest an obstruction, such is not usually the case and surgical intervention is not always necessary. The abdominal distension results primarily from distension of the urinary tract.
A 2-month-old infant developed severe methemoglobinemia following topical pharyngeal application of a common benzocaine containing agent ( Cetacaine ). Although a number of reports of this complication have appeared in recent years, this is apparently the first case reported in the Otolaryngology literature. The pathophysiology, pharmacology, and treatment of this condition are reviewed.
The finding of mature neuroglial tissue in a mass from the head and neck region of a child raises four differential diagnostic possibilities: teratoma, encephalocele, glioma, and heterotopic brain tissue. We present a review of the literature and discuss the clinical, radiographical, and pathological features of a rare nasopharyngeal brain heterotopia in an infant causing upper airway obstruction.
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