Biomedical subjects
Publications and source records attributed to P L'Heureux.
A case of pneumoperitoneum due to cocaine abuse is presented. Although most commonly associated with surgical disease, pneumoperitoneum may actually be a manifestation of non-surgical intrathoracic pathology. In this patient percutaneous diagnostic peritoneal lavage resulted in return of a large quantity of air and was negative for bleeding or contamination.
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Explore the source record for details and available documents.
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Sixteen infants under 11 weeks of age developed documented peptic ulcer disease involving the stomach, duodenum or pylorus during an eight-year period in a Newborn Intensive Care Unit. The precipitous onset of gastrointestinal bleeding and/or perforation commonly associated with ulcer disease in early infancy was present in only seven (44%) of the 16 patients. The remaining nine infants (56%) presented with recurrent emesis, a presentation of peptic ulcer disease rarely described in the first weeks of life. Contrast radiography was used to demonstrate a definite ulcer crate in 13 of these patients. Two had their ulcers diagnosed at surgery and one by endoscopy. Radiographic demonstration of pylorospasm and/or gastric retention was often associated with ulcer craters located in the pyloric channel or gastric antrum. Only two patients required surgery for massive bleeding and perforation. The remainder were successfully managed medically using orogastric suction antacids and gradual resumption of milk feedings. There were no deaths within our population attributable to peptic ulcer disease.
Three cases of unilateral pulmonary vein atresia in children are described. The findings in all three cases were similar and consisted of hemoptysis, recurrent pulmonary infections, and a normal size or small lung with reticular markings. In combination, these findings should allow one to strongly suspect the diagnosis which then can be confirmed with radionuclide perfusion studies and pulmonary angiography. Both procedures demonstrate decreased blood flow to the involved lung, but the pulmonary arteriogram is the definitive study in that it shows a small pulmonary artery, pruned peripheral branches, stasis of contrast material, and nonvisualization of draining pulmonary veins. The condition generally is believed to be congenital and related to the somewhat more common, but still rare, focal congenital pulmonary vein stenosis. Treatment consists of surgical removal of the involved lung or lobe.
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A false-positive 111In-labeled leukocyte scan was obtained in a girl with cystic fibrosis and infection. There was focal accumulation of 111In activity in the abdomen and marked pulmonary uptake. Surgical exploration and postmortem examination revealed no abdominal abnormality. The abnormal activity was apparently due to swallowed sputum which contained labeled leukocytes. Broader clinical implications are discussed.
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The unique CT features, heretofore unreported, of a case of cystic nephroma of childhood are presented. The concept that cystic nephroma is part of thc diagnosis of cystic nephroma can be made utilizing excretory urography and computerized tomography.
Sixteen patients with abdominal neuroblastoma had 99m Technetium Phosphate Compounds (99m TC-PC) bone scans as a preoperative evaluation for metastatic disease. Ten patients (62%) had extraosseous tumor uptake while six patients (38%) did not. There was no difference in the incidence of tumor calcification, tumor necrosis or hydronephrosis in the two groups. However, VMA levels were significantly higher in the group with extraosseous tumor uptake. Various bone seeking radionuclides are compared to 99m TC-PC and possible mechanism for extraosseous uptake of such radionuclides are postulated. Awareness of the frequency of such uptake should reduce the possibility of errors in the interpretation of bone scans in patients with neuroblastoma.
Three similar and unique, predominantly osteolytic lesions are reported in young patients between the ages of 4 and 19 years. Progressive back pain and neurologic deficits were the principal clinical features. The initial roentgenographic impression was that of a malignant tumor either primary or metastic. Despite incomplete resections of a firm, intraosseous and extradural tumor, healing has occurred during the follow-up interval with one interim exception. A spindle-cell stroma containing a variable number of giant cells was the consistent microscopic finding. Ultrastructural studies of one case revealed that the mononuclear spindle cells and giant cells contained cytoplasmic microfilaments similar to those of the myofibroblast. The possible relationship of this tumor to nodular fasciitis and desmoplastic fibroma is hypothesized in the light of the role of the myofibroblast in the fibromatoses and nodular fasciitis.
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A child with histiocytosis X initially diagnosed at the age of 4 months had a series of pulmonary biopsies later in the course of the disease. The specimens were examined by light and electron microscopy. The primary disease was complicated by Pneumocystis carinii pneumonia. This study demonstrates the limitation of light microscopy and the necessity of ultrastructural examination to verify the simultaneous occurrence of an infiltrative disorder such as histiocytosis X in the presence of an infection.
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Diaphragmatic paralysis has been mentioned infrequently as a cause of respiratory symptoms in children. During a three-year period, diaphragmatic paralysis has occurred in 12 neonates following birth trauma (six) or thoracotomy (six) and in four older children following thoracotomy. Spontaneous recovery occurred in all four older children and in five of the 12 neonates. Although two neonates became asymptomatic despite persistent paralysis, the remaining five neonates required prolonged intermittent positive-pressure breathing; two eventually died of secondary pneumonia, and three became asymptomatic only after plication of the affected diaphragm.