Search PubMed⌕ Search

Biomedical subjects

N T Griscom

Publications and source records attributed to N T Griscom.

At least 19 recordsLinked to original sources
PubMed1992

Caldwell Lecture. Respiratory problems of early life now allowing survival into adulthood: concepts for radiologists.

Many patients with illnesses that once were fatal at birth or during childhood now survive into adult life. This article considers four respiratory illnesses of early life in which long-term survival now occurs frequently: cystic fibrosis, diaphragmatic hernia, esophageal atresia-tracheoesophageal fistula, and bronchopulmonary dysplasia. In cystic fibrosis, although the median age at death is now 25 years, chronic pulmonary infection due ultimately to the abnormal composition and clearance of airway mucus is still the usual cause of death. Earlier survivors of congenital diaphragmatic hernia had only minor diminution of perfusion and ventilation of the lung on the side of the hernia as adolescents or young adults; however, as infants with greater degrees of pulmonary hypoplasia have successful repair of their hernias, more long-term respiratory impairment will probably be found. The esophageal atresia tracheoesophageal fistula complex leaves all esophagi and many tracheas permanently abnormal; recurrent aspiration, repeated pneumonia, and an unduly collapsible trachea are the result, although symptoms may be few. Survivors of bronchopulmonary dysplasia have decreased exercise capacity, wheezing, and recurrent pneumonia, although their chest radiographs may become normal or almost normal.

Adult↗
PubMed1991

CT quantitation of tracheal cross-sectional area as a guide to the surgical and anesthetic management of children with anterior mediastinal masses.

Pediatric patients presenting with anterior mediastinal masses between January 1980 and November 1988 were reviewed to assess the correlation between tracheal cross-sectional area and anesthetic risks. Forty-two patients had evaluable computed tomography (CT) scans and underwent a surgical procedure. Thirty-four patients had Hodgkin's disease, six had non-Hodgkin's lymphoma, and two had mediastinal teratoma. Tracheal cross-sectional areas were greater than 75% of expected in 19 cases, greater than 50% to 75% in 16 cases, greater than 25% to 50% in five cases, and less than or equal to 25% in two cases. The presence or extent of symptoms did not correlate well with the degree of tracheal narrowing shown by CT scan except for orthopnea. Local anesthesia was used primarily in patients with significant tracheal narrowing (tracheal size was less than or equal to 56% in 5 of 6 patients). General anesthesia with spontaneous ventilation by mask was performed in four patients with tracheal areas of 33%, 73%, 76%, and 98% of expected. General endotracheal anesthesia was utilized in the remaining 32 patients, only three of whom had tracheal areas of less than 50% of expected (down to 30%, 26%, and 24% of expected) and one received preoperative radiotherapy (26%). None of these 32 patients had symptoms of orthopnea or dyspnea at rest, and only one had dyspnea on exertion. All tolerated anesthesia without difficulty. No patient in this series suffered respiratory or cardiovascular collapse during surgery. Adequate biopsy material was obtained in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Radiographic findings associated with surfactant treatment.

Radiographs of the chest (CXR) were evaluated in 35 of 41 infants enrolled in a randomized controlled trial of modified bovine surfactant extract (Surfactant-TA Tokyo-Tanabe) treatment. Infants between birthweight 1000 and 1500 gm with respiratory distress syndrome requiring mechanical ventilation and an inspired oxygen concentration 0.4 or greater were randomly assigned to either a single intratracheal dose of saline or surfactant-TA prior to 8 hours of age. Radiographs obtained prior to treatment and 24 hours after treatment were reviewed by a radiologist (N.T.G.) without knowledge of treatment group. Evaluation consisted of a score including criteria for inflation of the lungs, density of the lungs, and extent of air bronchograms. Pneumothorax, pulmonary interstitial emphysema, and asymmetric parenchymal involvement were noted as well. No significant difference in CXR scores were noted in the two groups, before or after treatment. There was a greater incidence of pneumothorax and pulmonary interstitial emphysema in the control infants, which supports the role of surfactant in preventing barotrauma. Increased incidence of asymmetric parenchymal involvement was noted in the surfactant-treated infants. Further study of the possibility of drug maldistribution is warranted.

Female↗
PubMed1990

The trachea and esophagus after repair of esophageal atresia and distal fistula: computed tomographic observations.

Five patients, whose esophageal atresia and distal tracheoesophageal fistula had been repaired in infancy, were examined by computed tomography at age 2 to 21 because of recurrent or persistent tracheal or esophageal problems. Their tracheas generally failed to have the roughly circular cross-sectional shape found in controls. The pars membranacea was often unusually broad, with much more section-to-section variation in area than in controls. Change in cross-sectional area with respiratory phase, in the one patient assessed, was much greater than in a control. These tracheal abnormalities help to explain the tracheal symptoms found in these and similar patients. Their esophagi contained much air and fluid.

Adult↗
PubMed1989

Dimensions of the trachea to age 6 years related to height.

In an effort to establish normal values for both investigational and patient care purposes, computed tomography was used to determine the length, diameters, cross-sectional area, and volume of the tracheas of 34 children up to the age of 6 years. The measurements were taken when patients were asleep or resting quietly during tidal breathing, at perhaps 30-60% of total lung capacity. The results were related to body height (in infancy, to body length). There was virtually no difference between boys and girls. Each mean diameter correlated well with mean cross-sectional area. Tracheal diameters and area were reasonably constant over the length of individual tracheas. The slopes of the functions relating height to tracheal dimensions in these 34 infants and young children were slightly less steep than those previously measured near total lung capacity in 90 older children and adolescents.

Analysis of Variance↗
PubMed1989

Bronchopulmonary dysplasia: radiographic appearance in middle childhood.

Chest radiographs were compared for three groups of children 8-9 years old: 23 survivors of bronchopulmonary dysplasia (BPD), 33 survivors of hyaline membrane disease without BPD, and 35 survivors of premature birth without neonatal respiratory problems. Only four children in the second group and three in the third had abnormal lungs. Linear shadows, apparently representing strands of fibrosis or deep pleural fissuring, were seen more frequently (15 of 23) in the BPD group than in the others (P less than .0001). Seventeen children in the BPD group had definite pulmonary abnormalities, none of them severe. The anteroposterior dimension of the chest in survivors of BPD tended to be decreased (P less than .001 vs that of reported control subjects).

Aging↗
PubMed1989

Apparent association between thymic cysts and prior thoracotomy.

Three male subjects, aged 8 months to 18 years, who had previously undergone thoracic surgery, developed mediastinal thymic cysts. Two cysts, both multilocular, were shown by plain radiography and computed tomography, and one was found incidentally during cardiac surgery. These three cysts constitute 15% of the 20 thymic cysts removed surgically or found at autopsy at the authors' hospital in the past 27 years. These cases and three previously reported cases in male adolescents and adults suggest that some thymic cysts are related to trauma during surgery.

Adolescent↗
PubMed1979

Neonatal intestinal opacification secondary to transplacental passage of urographic contrast medium.

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.

Adult↗
PubMed1979

Amniography in second trimester diagnosis of myelomeningocele.

Twenty-eight fetuses, at 14-22 gestational weeks, were examined by amniography to identify a thoracic, lumbar, or sacral myelomeningocele. The end point was a fluoroscopic spot film with the fetal back in profile, to show the presence or absence of a bulging midline mass. Fetal irradiation was 0.66 rad +/- 0.36 (SD). There were 26 true negatives and one indeterminate examination. The one true positive was in a patient who had just had negative real-time ultrasonography. It is suggested amniography be used (1) when ultrasonography and amniotic fluid alpha fetoprotein determination disagree about the presence of a neural tube defect, and (2) for further confirmation when both these tests are positive.

Adult↗