Biomedical subjects
Publications and source records attributed to P Winchester.
Retroperitoneal fibrosis is rarely considered in the differential diagnosis of ureteral obstruction in children even when clinical presentation and radiologic findings are typical. In a 12-year-old boy admitted with a 2-week history of flank pain computed tomography showed an enhancing mass obstructing the left ureter. Pathologic examination of the mass and adjacent segment of ureter revealed retroperitoneal fibrosis.
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Two cases of spontaneous resolution of large ovarian cysts in newborns are presented. In both cases the cysts were detected prenatally with ultrasound. In one case the cyst disappeared before birth; in the other, the cyst resolved several weeks postnatally. Both infants also displayed labial, uterine and vaginal enlargement, signs of maternal estrogen stimulation. These large ovarian cysts are also most likely under some hormonal stimulation and may undergo spontaneous resolution and therefore obviate the need for surgery.
A 13-year-old girl developed Addison's disease during antituberculous therapy for presumed tuberculous ventriculitis. CT of the abdomen showed diffusely enlarged hypodense adrenals and a hypodense lesion in the lower pole of the left kidney. Biopsy of the renal lesion revealed caseating and noncaseating granulomas.
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Acute intramural duodenal-jejunal hematoma is a classical finding in the battered child syndrome. The radiographic findings of a large obstructing intramural mass associated with the "coiled-spring" appearance generally raise the question of child abuse in any patient without appropriate accidental injury. In this study the radiologic features of resolving duodenal-jejunal hematoma are detailed in five abused children. The results show that the coiled-spring appearance is an acute phenomenon associated with a well-localized intramural hematoma. In the resolving phase, localized mural masses in the lateral aspect of the descending duodenum and fold thickening are indications of prior intramural hemorrhage. When these radiologic features are encountered in a child with nonspecific abdominal complaints, child abuse should be suspected. Furthermore, in patients with suspected occult trauma, resolution of abdominal symptoms should not deter the radiologist from performing an upper gastrointestinal tract series, which may provide evidence of child abuse.
The premature infant brain has been thoroughly studied by sonography, and normal standards for ventricular size have been established. Whether these apply to normal full-term infants is uncertain. Fifty-three healthy full-term infants were electively examined by real-time sonography through the anterior fontanelle on the first to sixth days of life. Nine had asymmetric lateral ventricles; two of these had unexpected evidence of intracranial hemorrhage, while a third had a ventricular cyst. Forty-four infants had symmetric ventricles, but in 36 the ventricles had little or no cerebrospinal fluid. Vaginal delivery had a statistically significant association with these "compressed' lateral ventricles. This study indicates that seemingly healthy infants may have unsuspected intracranial hemorrhage, that asymmetric ventricular size may be normal, and that shortly after birth most healthy infants have "compressed" lateral ventricles that should not be interpreted as cerebral edema.
Two adolescents with psoas muscle abscesses secondary to Crohn's disease are presented. Musculoskeletal signs of hip flexion and scoliosis led to early clinical suspicion. Computed tomography and ultrasonography demonstrated the extent of involvement and allowed specific preoperative diagnosis.
A 14-month-girl presented with an asymptomatic posterior mediastinal mass. She had a history of prematurity, umbilical artery catheterization, and sepsis. The diagnosis of aortic aneurysm was made by dynamic computed tomography. The aneurysm was successfully resected.
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Cyclical electrical stimulation has been applied to 10 hemiparetic patients with clinical signs of knee joint spasticity. The programme included 30 minutes of stimulation to the hamstrings followed by another 30 minutes of stimulation to the hamstrings and quadriceps. None of the patients experienced increased spasticity. The reduction in spasticity ranged from none to substantial with some other beneficial side-effects. No conclusions could be drawn as to whether hamstring stimulation is preferred to combined stimulation or to quadriceps stimulation alone. It is suggested that small portable stimulators be introduced for chronic use in spastic patients after an optimum stimulation regimen is individually established for each patient.
Positional feedback stimulation training and cyclical electrical stimulation were used in combination as a treatment for facilitating knee extension in hemiparetic patients. Forty adult hemiparetic patients who demonstrated minimal active control of their quadriceps femoris muscles were randomly assigned to control or study groups. The control patients received a program of physical therapy, and the study patients received the positional feedback stimulation training in addition to their therapy program. The stimulation training provided the patient with immediate auditory and visual feedback of his changing joint angle while he voluntarily extended his knee. When the patient reached a near maximal extension effort, electrical stimulation of the quadriceps femoris muscle was automatically triggered, completing the patient's available range of motion in extension. The stimulation training was supplemented with two hours of cyclical electrical stimulation daily. At the end of four weeks, analysis revealed a statistically significant increase in knee extension torque and active synergistic range of motion in the study group. No change was noted in their ability to extend their knees using isolated quadriceps femoris muscle control. This study suggests that positional feedback stimulation training is effective when used to augment a facilitation program for improving knee extension control in hemiparetic patients.
Cholelithiasis is very rare in the newborn infant and is usually not recognized until surgery or autopsy following perforation of the biliary tree. Two premature infants had calcified gallstones on abdominal radiographs. In one patient portal vein thrombosis was also present. The other had been treated with total parenteral nutrition (TPN) and furosemide which have recently been implicated in the development of gallstones in premature infants.
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Four immunologically compromised children, two with acute lymphoblastic leukemia who received immunosuppressive therapy, one with X-linked agammaglobulinemia, and one with chronic granulomatous disease of childhood, displayed both the pulmonary and gastrointestinal mechanisms that led to pneumatosis intestinalis. Consideration of both the basic disease and the immediate clinical circumstances that surround the development of intramural air are helpful in the determination of the significance of pneumatosis intestinalis in individual patients.
Neonatal osteomyelitis presents with few clinical signs despite multiple sites of involvement. Four cases of osteomyelitis due to Staphylococcus aureus or Candida albicans were encountered in a neonatal intensive care unit. Three were unsuspected clinically and were detected as incidental radiologic findings. The fourth presented with soft-tissue abscesses. Long bone metaphyses were most frequently affected. Other sites included iliac bones, clavicles, and spine. On follow-up the bones healed, but one patient was left with hip deformity secondary to destruction of the cartilaginous femoral heads and another patient developed obstructive hydrocephalus due to Candida ventriculitis. Complete skeletal survey is indicated in any infant with osteomyelitis at one site to seek additional silent areas of involvement.