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Biomedical subjects

R B Towbin

Publications and source records attributed to R B Towbin.

At least 55 records · Page 3Linked to original sources
PubMed1990

Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children.

A retrospective study was performed to determine the clinical and pathologic features, etiology, and outcome of children with the reversal sign. The reversal sign, a striking CT finding, probably represents a diffuse, anoxic/ischemic cerebral injury. CT features of the reversal sign are diffusely decreased density of cerebral cortical gray and white matter with a decreased or lost gray/white matter interface, or reversal of the gray/white matter densities and relatively increased density of the thalami, brainstem, and cerebellum. Twenty children with the reversal sign were retrospectively analyzed. We divided the patients into three groups: (1) acute reversal, (2) intermediate group, and (3) chronic reversal. There were nine cases of trauma (seven of child abuse); nine hypoxia/anoxia incidents (birth asphyxia, drowning, status epilepticus); one bacterial meningitis; and one degenerative encephalitis. All acute- and intermediate-group patients had respiratory problems requiring ventilator support and intensive care. In five of seven patients who died, autopsy findings were consistent with anoxic/ischemic encephalopathy. Surviving patients have profound neurologic deficits with severe developmental delay. The CT reversal sign carries a poor prognosis and indicates irreversible brain damage.

Brain Edema↗
PubMed1989

Cranial chordomas in infancy and childhood. A report of two cases and review of the literature.

Cranial chordomas are uncommon, accounting for less than 1% of all intracranial neoplasms. Although they are presumed to arise from congenital notochordal remnants, it is rare for these tumors to present in childhood. Only 35 cases of cranial chordomas have been reported in children 16 years of age or younger. We report 2 additional cases of pediatric cranial chordomas. One occurred in a 4 month old infant and to our knowledge represents the earliest age of presentation yet reported. The second case documents the value of MR imaging in delineating the extent of the tumor and defining its relationship to adjacent structures.

Child↗
PubMed1989

Computed arthrotomography as an adjunct to pediatric arthrography.

Computed arthrotomography was compared with conventional arthrography in ten cases and with both pluridirectional arthrotomography and conventional arthrography in five cases. Six elbows, five hips, three ankles, and one wrist were examined. Indications included pain, locking, congenital hip dislocation, posttraumatic joint deformity, and postinfectious joint deformity. Compared with conventional arthrography, computed arthrotomography provided additional information in ten of 15 (67%) cases and provided the same information in four cases. Arthrography and computed arthrotomography were complementary in one case. Compared with pluridirectional arthrotomography, computed arthrotomography provided additional information in two of five (40%) cases. In the remaining three cases, computed arthrotomography and pluridirectional arthrotomography provided equal information. In no case did pluridirectional arthrotomography provide additional information. Computed arthrotomography was useful in demonstrating loose bodies, differentiating air bubbles from loose bodies, and determining the intra- or extraarticular location of ossific densities. Computed arthrotomography appears to be a useful adjunct to arthrography in detecting loose bodies and in evaluating anatomically complex cases.

Adolescent↗
PubMed1989

Percutaneous drainage of chest abscesses in children.

Seven patients ranging in age from 3 to 18 years underwent percutaneous drainage of eight intrathoracic abscesses. Five of the abscesses were mediastinal or paramediastinal and resulted from esophageal perforation or esophageal anastomotic leakage. The abscesses resolved in each case, with a mean catheter drainage time of 28 days and no need for surgical intervention. Three of the abscesses were intrapulmonary, and each lay adjacent to a pleural surface. All three lung abscesses resolved within 19-24 days, without thoracotomy or wedge resection.

Abscess↗
PubMed1989

Neuroaudiologic abnormalities in patients with type 1 neurofibromatosis.

Although the protean manifestations of neurofibromatosis have been studied for many years, much is yet to be learned about this disease in young children. Specifically, little is known about the prevalence and significance of early neurotologic abnormalities in this population. Our review of the recent literature, however, failed to identify any publication on the use of ABR and acoustic reflex testing in the pediatric neurofibromatosis population. This study reports on a standardized differential diagnostic battery conducted on 44 children diagnosed as having neurofibromatosis. Results of the neuroaudiologic battery indicated that 32% of the children had significant abnormalities on ABR and acoustic reflex dynamic tests. This is a substantially higher prevalence of abnormalities than reported by another group at a recent NIH concensus meeting on neurofibromatosis. Discussion of the implications of these findings regarding evaluation protocols, as well as management for this select patient population, will follow.

Acoustic Impedance Tests↗
PubMed1988

Percutaneous gastrostomy and percutaneous gastrojejunostomy in children: antegrade approach.

Twenty-five percutaneous gastrostomies and nine percutaneous gastrojejunostomies were performed in 24 children aged 4 months to 22 years. Indications for percutaneous gastrostomy included severe injury to the central nervous system (nine patients), malignancy (seven patients), failure to thrive (four patients), degenerative central nervous system disease (one patient), and miscellaneous conditions (three patients). All procedures were performed under local anesthesia and sedation. An antegrade approach is described for percutaneous gastrostomy and percutaneous gastrojejunostomy placement. No major complication occurred, and only three skin infections have been encountered. The children were evaluated and followed up by a nutritional support team. Early experience with percutaneous gastrostomy and percutaneous gastrojejunostomy in the pediatric population suggests that the technique is safe and applicable to children of all ages and sizes. In particular, the antegrade approach appears to be an acceptable solution for enteric alimentation.

Anesthesia, Local↗