Biomedical subjects
Publications and source records attributed to J O Haller.
A method of transumbilical selective angiography in the newborn using the Seldinger method is presented. Side-hole catheters are unsuitable, and a 5-French polyvinyl catheter is specified.
Neonatal small left colon syndrome is a cause of functional colon obstruction in newborn infants, with a high association of maternal diabetes. There has been much confusion regarding its relationship to meconium plug syndrome and aganglionosis. Six cases of aganglionosis (2 in infants of diabetic mothers) were encountered in which the radiographic findings were identical to small left colon syndrome, indicating the need for caution in dismissing aganglionosis solely on the basis of a small left colon seen radiographically in a newborn infant with colon obstruction. Small left colon and meconium plug syndrome are overlapping entities in the total spectrum of functional intestinal obstruction in newborn infants.
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Three patients with a left arch and a right descending aorta are described, all presenting in infancy. In one patient the abnormality was acquired, yet the radiological appearances were very similar. The place of the barium swallow in the diagnosis is discussed, and it is concluded that aortography is required for a definitive diagnosis.
Although rarely recognized, traumatic pharyngeal and cervical esophageal pseudodiverticula are probably not infrequent in newborns who have undergone vigorous oropharyngeal suctioning and endotracheal intubation. This report describes four premature infants with clinically unsuspected retroesophageal false passages incidentally discovered on chest radiographs. Differentiation of pseudodiverticula from spontaneous rupture of the middle or distal esophagus can be achieved by careful inspection of the course of the feeding catheter in frontal and lateral projections and by partial withdrawal of the catheter to permit injection of the retroesophageal false passage with a small volume of water-soluble contrast material.
Sonograms were performed on 144 pediatric patients ranging in age from 2 months to 15 years during a recent 26 month period. The main indications for pelvic sonography were to confirm pregnancy prior to elective abortion; to exclude pregnancy in girls with pelvic masses and/or secondary amenorrhea prior to extensive radiographic studies; to confirm or rule out the presence of pelvic masses; to delineate the extent and internal structure of pelvic tumors; and to exclude ovarian tumors in girls with precocious sexual maturation. Normal sonograms in girls with suspected pelvic tumors usually eliminated the need for additional radiographic studies. Because of technical problems and inherent limitations of present imaging techniques, sonography has an ancillary role in the investigation of patients with abnormal or ambiguous genitalia.
Adrenal neuroblastomas are usually diagnosed by intravenous urography because of the displacement of the kidney or distortion of its contour. This report describes five children with left adrenal neuroblastoma where the mass was purely anterior to the kidney and produced displacement vectors similar to tumors in the body or tail of the pancreas.
The authors report 2 radiographic findings that have not previously been described in patients with cystic fibrosis: (1) the linear form of pneumatosis coli (2) large pancreatic concretions which resembled the pancreatic calcificaitons of hereditary pancreatitis. The patient with pancreatic calcification also had labile diabetes and episodes of ketoacidosis, unusual complications of cystic fibrosis.
The authors describe a simple method of sonographic localizaiton for renal biopsy in unanaesthetized pediatric patients. Adequate biopsies have been obtained in 6 of 7 patients who ranged from 2 months of 8 years in age.
The authors describe two children with crossed, fused renal ectopia in whom severely damaged hydronephrotic ectopic kidneys were not shown by intravenous urography. Aortography confirmed the diagnosis in both patients. Aortography is of great value if a diseased ectopic kidney must be resected; demonstration of the vascular supply to both kidneys enables the surgeon to preserve all of the normal renal tissue.
Calcified thrombi in the prerenal (suprarenal) segment of the inferior vena have a characteristic radiographic appearance that permits accurate "plain film" diagnosis. Most have been fortuitously discovered in infants and young children. None of the affected individuals has had clinical evidence of venous obstruction. Vena caval obstruction is usually incomplete. Uncalcified clot caudal to the calcified thrombus caused complete obstruction of the inferior vena cava and renal veins in one of our patients, a healthy infant; since collateral flow was adequate surgery was not advised. We believe that aggressive diagnostic and therapeutic measures are unnecessary in the management of infants and children with calcified thrombi in the inferior vena cava.
Two cases of curvilinear lateral ureteral displacement in children with abdominal masses are reported. The masses proved to be sigmoid fecal impactions. This possibility must be considered before embarking on radiographic or surgical evaluation of possible retroperitoneal neoplasm.
Selective filtration, high kilovoltage, and fine focal spot magnification produce detailed radiographs of the airway of infants and small children. This technique has been applied to the study of upper airway obstruction in the glottic, subglottic, and supraglottic areas. Its great diagnostic yield is accompanied by a reduction in radiation dose compared to that of a nonfilter technique. The physical factors dictating choice of filter and film-screen combination are discussed.
Frontometaphyseal dysplasia is a syndrome that encompasses cranial hyperostosis, abnormal tubulation of cylindrical bones, and other skeletal and extraskeletal abnormalities. The most striking features are overgrowth of the supraorbital ridges which results in a Mephistophelian facial appearance and a radiographic configuration of the skull that has been likened to a soldier's helmet. Most patients have severe hearing loss, defective dentition, poorly developed musculature, and joint contractures. Dominant inheritance has been suggested in previous reports, but an appropriate pedigree has been documented in only one family. This paper describes three additional patients in two unrelated families: (1) an 8-year-old boy whose mother has mild metaphyseal dysplasia and several minor skeletal abnormalities that have occurred in patients with the syndrome; and (2) two maternal half-brothers. These cases provide additional evidence that frontometaphyseal dysplasia is an autosomal dominant trait with variable penetrance.
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Two cases of pancreatitis associated with the trauma of child abuse are reported. In the first case the skeletal survey was initially negative but the child later showed widespread roentgen evidence of intramedullary necrosis and periosteal new bone reaction. These lesions healed without treatment. In the second patient, the pancreatitis was accompanied by ascites and subsequently by bile peritonitis, duodenal obstruction, and a bile-filled abscess in the pancreas. This patient had skeletal fractures. The clinical problems of these 2 patients emphasize the need not only to relate pancreatitis to the battered child syndrome but also to distinguish between the bone changes due to direct trauma and those related to pancreatitis.
Two patients are reported with the clinical and roentgenographic findings of the Weissenbacher-Zweymuller syndrome. The features are neonatal micrognathia (Pierre Robin syndrome), rhizomelic chondrodysplasia with dumbbell shaped femur and humeri. The bone changes tend to regress and there is normal growth on serial studies. A third case seemed at birth to show similar roentgenographic changes but was dwarfed; serial observations revealed him to be a case of the Kniest syndrome with micrognathia as an added feature. The term "micrognathic dwarfism" suggested by Maroteaux is probably best aboided since it will inevitably include a variety of conditions, only some of which are associated with dwarfism.
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