Biomedical subjects
Publications and source records attributed to M A Radkowski.
The case of a newborn infant with a high-grade ureterovesical junction obstruction--a primary obstructive megaureter--who presented with a perirenal pseudocyst (urinoma) is discussed. Radionuclide studies allowed recognition of this collection and led to the discovery of the ureteral obstruction. The rarity of urinomas in neonates and the scintigraphic appearance of urinomas are emphasized.
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Chlamydia trachomatis was recently discovered to be the causative organism in a distinctive afebrile pneumonia occurring in infants under 6 months of age. Experience with the first 125 cases seen at this hospital during a 3 1/2 year period is reported. Chest radiographs were reviewed of 2,273 infants in this age group with signs of lower respiratory tract infection. The first group comprised 148 patients admitted to the hospital. Chlamydia pneumonia was diagnosed in 41 cases. The second group of 2,125 infants was first seen in the outpatient department where 84 additional cases were detected. From this experience it was concluded that, although there are no radiographic findings specific for Chlamydia pneumonia, a combination of the clinical and radiographic findings strongly suggests the diagnosis before cultures and serum antibody titers are available. Important clinical features include age of onset at 2-14 weeks of age, cough, lack of fever, and elevated serum immunoglobulins. Most chest films show bilateral hyperexpansion and diffuse infiltrates with a variety of radiographic patterns including interstitial, reticular nodular, atelectasis, coalescence, and bronchopneumonia. Pleural effusion and lobar consolidation are not seen. The radiographic changes often suggest a more serious illness than that observed clinically. Radiographic features are described in detail.
Gallium-67 scan results were correlated with the long-term clinical course in ten children with neuroblastoma. The four patients whose primary tumor did not accumulate gallium have exhibited a significantly better survival time (mean duration 68.2 months) as compared to the six patients with gallium-positive tumors (mean duration 16.6 months, P < 0.001). This difference in survival was not explainable on the basis of accepted prognostic indicators, such as age of patient or stage of disease at initial diagnosis. These results indicate that gallium uptake may be a useful prognostic indicator in children with neuroblastoma, independent of other variables.
Neonatal intestinal opacification in five infants (one set each of triplets and twins) after maternal excretory urography is described, and mechanisms leading to this phenomenon are discussed. Transplacental passage of urographic contrast medium with subsequent excretion by the fetal kidneys and possibly liver and small bowel seems to explain the radiographic appearance. Although the contrast medium probably does not harm the fetus, it should be distinguished from other more sinister causes of colonic opacification in the neonate.
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A retrospective and prospective analysis of children with a diagnosis of complete absence of the corpus callosum (ACC) at the Children's Memorial Hospital in Chicago over a 5-year period was performed. The diagnosis was based on the computed tomography (CT) and/or magnetic resonance (MR) images. From this material, 105 children with a diagnosis of ACC were analyzed on the basis of clinical symptomatology and radiological studies (CT, MR and ultrasound). Eighty-three percent of our children were symptomatic. The most common symptoms and signs were macrocephaly with hydrocephalus and seizures. MR was the best radiological imaging modality for evaluating children with ACC and associated brain anomalies. The most common associated brain anomalies with ACC in decreasing frequency in our children were: interhemispheric cyst with hydrocephalus, Dandy-Walker malformation, migrational disorders, absence of the inferior vermis, cephaloceles and lipoma of the interhemispheric fissure.
A retrospective study of 40 children with some form of pachygyria was performed at the Children's Memorial Hospital in Chicago. All 40 children had MR brain scans. We analyzed the MR findings, and correlated these findings with the clinical symptoms and course in all the children. We have autopsy findings in 15% these children. Based on our clinical, MR and autopsy findings, in conjunction with the medical literature, we found the following: (1) Pachygyria can occur as an isolated entity without an association with lissencephaly. The MR findings in these children consisted of a brain that demonstrated normal opercularization with either focal or diffuse areas of pachygyria without areas of agyria. These children live longer and have less severity of symptoms than the children with lissencephaly. (2) The MR findings in children with lissencephaly consisted of a brain that demonstrated abnormal opercularization with areas of total agyria or areas of agyria with pachygyria. (3) The MR findings in 25% of our children with polymicrogyria simulated pachygyria. The MR findings of the brain in these children consisted of a 'nubby' appearance to the outer surface of these abnormal gyri which resembled pachygyria but on histologic exam was polymicrogyria.
Twelve neonatal brain tumors, presenting within 60 days of birth, constituted 3.3% of pediatric brain tumors. Three-fourths were supratentorial. Two-thirds were benign. Forty-two percent were choroid plexus papilloma. Twenty-five percent were teratoma. Eight percent each were hypothalamic glioma, gliosarcoma, medulloblastoma, and primitive neuroectodermal tumor. Clinical symptoms were nonspecific. Signs of herniation were absent in all 12 patients. Forty-two percent of these patients died 1 day to 8 months after diagnosis. Ultrasound, CT, and magnetic resonance have all proved useful for displaying these lesions suitably for surgery.
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