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Biomedical subjects

S K Fernbach

Publications and source records attributed to S K Fernbach.

At least 73 records · Page 4Linked to original sources
PubMed1985

Bone changes from prostaglandin therapy.

Prostaglandin E therapy in infants causes periosteal elevation. Although the changes usually take 30-40 days to become visible, we have seen them as early as nine days. In 15 infants who had prostaglandin E therapy for over six days, three developed periosteal elevation. Three other cases are described in greater detail, with long-term follow-up in two in which the bone remodeled to normal. Gallium scan in one showed increased uptake in areas involved. The periosteal cloaking may mimic Caffey disease but the pattern of involvement is different, since the mandible, which is commonly affected in Caffey disease, is rarely involved in prostaglandin E therapy.

Bone and Bones↗
PubMed1985

Derangement of swallowing in children with myelomeningocele.

Barium esophagrams performed in 13 children with myelomeningocele demonstrated a variety of swallowing disorders: difficulty in bolus formation, nasopharyngeal reflux, tracheobronchial aspiration. Cricopharyngeal spasm was not identified in this group. Antegrade peristalsis in the distal two-thirds of the esophagus was normal. Gastroesophageal reflux was demonstrated in 8 of the children. Vocal cord paralysis (8/13) and death in early children (7/13) occurred with greater frequency than in the general myelomeningocele population. Correct management of these children may require tracheostomy, gastrostomy, and fundoplication.

Barium Sulfate↗
PubMed1985

Greater trochanteric overgrowth: development and surgical correction.

Greater trochanteric advancement (GTA) is an orthopedic procedure designed to correct the biomechanical consequences of overgrowth of the greater trochanter by moving the greater trochanter and its attached muscles laterally and distally. Thirty-one children with trochanteric overgrowth who had secondary pelvic instability (Trendelenburg sign) were studied and underwent a total of 33 GTA procedures. The clinical and radiologic prerequisites for successful surgery are presented. In addition, the radiographic methods of measuring the lateral position of the trochanter, the articulotrochanteric distance, and the amount of trochanteric overgrowth are discussed. Measurements made on preoperative and postoperative radiographs revealed that surgery achieved a mean displacement laterally of 12.1 mm and distally 21 mm. Clinically, there were few complications (two children with mild myositis, one with broken hardware, one with delayed union of trochanter). Pelvic instability had disappeared in the 25 of the 30 patients who could be evaluated.

Adolescent↗
PubMed1985

Gallium scintigraphy in American Burkitt lymphoma: accurate assessment of tumor load and prognosis.

The radiographic evaluation of 18 children with American Burkitt lymphoma was analyzed retrospectively. Pretreatment gallium-67 (67Ga) scintigraphy, done in 12 children, was interpreted as normal in only three children. In the other nine children, 67Ga scans demonstrated more sites of tumor involvement than any other method. Pretreatment abdominal computed tomography and sonography were valuable for evaluating ascites, density and size of the liver and spleen, renal involvement, and the presence of lymphomatous soft-tissue masses. Sonography was less accurate at localizing tumor deposits, but more sensitive to small amounts of ascites. Any of these methods is an effective way of following response to chemotherapy. However, it appears that sequential 67Ga scintigraphy may have significant prognostic value, as those children whose scintigrams reverted to normal within 6 months have survived.

Adolescent↗
PubMed1984

Computed tomography of primary intrathecal Wilms tumor with diastematomyelia.

A 2-year-old girl evaluated for diastematomyelia proved to have nearly complete block from an associated primary intraarachnoid Wilms tumor (nephroblastoma) situated immediately caudal to the bone spur and dorsal to the reunited hemicords and conus medullaris. No second focus of Wilms tumor could be detected. The computed tomographic appearance of the tumor and a possible embryological explanation for its relationship to the spinal cord are presented.

Child, Preschool↗
PubMed1984

John Caffey Award. Sonography of the caudal spine and back: congenital anomalies in children.

Articulated-arm, B-mode 3.5-5.0 MHz sonograms from 27 children with congenital anomalies of the caudal spine were analyzed retrospectively and correlated directly with patient appearance, preoperative myelograms, intraoperative photographs, and pathologic specimens to determine how effectively sonography could display the major pathologic features known to be present. Anterior spina bifida, posterior spina bifida, and (partial) sacral agenesis were displayed as focal absence of normal spinal echoes and distortions of the paraspinal/gluteal muscles. Subcutaneous anechoic spaces continuous with the spinal canal through a spina bifida identified the presence, site, and configuration of each meningocele present. Highly echoic masses were easily discerned at the sites of 14 of 16 lipomas and at the solid fibroadipose portions of both sacrococcygeal teratomas. Echoes from the surface of the spinal cord and occasionally from the central canal identified abnormally low cord position in 16 of 17 cases and identified herniation of the cord (or filum) into a concurrent meningocele in seven of 10 cases. Sonographic display of an anechoic meningocele bordered by a lobular, highly echoic, subcutaneous lipoma that inserted onto a low-lying or herniated spinal cord reliably identified lipomyelomeningocele. Despite limitations discussed in the text, initial experience suggests that sonography will be a useful method for screening patients for possible tethered spinal cord, (lipo)(myelo)meningocele, sacrococcygeal teratoma, and other anomalies of the caudal spinal axis.

Child↗
PubMed1984

The radiographic findings in severe rotavirus-induced colitis.

Rotavirus infections are a common cause of childhood gastroenteritis but are rarely severe enough to justify radiographs. However, there appears to be a small subset of children in whom a rotavirus-induced diarrheal illness accompanied by bloody stools is sufficiently severe and protracted to warrant barium studies. We have observed spasm and minute mucosal ulcerations of the colon in three of these children. These findings, under other circumstances, would have prompted the diagnosis of ulcerative colitis. These children also had a variety of other findings, such as osteomyelitis, intraocular mycetoma, and positive blood cultures. We suggest that when bloody diarrhea follows or accompanies a typical viral illness, rotavirus particles or antibodies be sought. This may prevent misdiagnosis of ulcerative colitis and unnecessary treatment with steroids.

Barium Sulfate↗
PubMed1983

Incomplete renal duplication obscuring ipsilateral complete duplication.

Renal duplication is not an uncommon anomaly of the urinary tract. However, we report a case in which the occurrence of incomplete duplication of a large lower pole, with an unusual side-by-side orientation of the lower pole segments, delayed recognition of the clinically troublesome ipsilateral upper pole duplication.

Child, Preschool↗
PubMed1982

Obstructive sleep apnea in infants and children.

Twenty-two infants and children were found to have clinically significant obstructive sleep apnea. A history suggesting complete or partial airway obstruction during sleep was obtained on all patients, and physical examination of the sleeping patient revealed snoring, retractions, or OSA in 21 patients. Nevertheless, the mean delay in referral for 20 patients first seen after the neonatal period was 23 +15 (+ SD) months. Sixteen of 22 patients (73%) developed serious sequelae: cor pulmonale in 12 (55%), failure to thrive in six (27%), permanent neurologic damage in two (9%), and behavioral disturbances, hypersomnolence, or developmental delays in five (23%). Clinical and radiologic evaluations revealed anatomic abnormalities which narrowed the upper airway in 21 patients; enlarged tonsils and/or adenoids in 14, micrognathia in three,generalized facial abnormalities in three, and cleft palate repair/tonsillar hypertrophy in one. In five patients, upper airway fluoroscopy was performed and was helpful in establishing the site and mechanism of obstruction. Polygraphic monitoring was utilized to quantify the frequency and duration of OSA. Prolonged partial airway obstruction during sleep resulted in significant hypercarbia in 11 patients and hypoxemia in five. Twenty patients improved after surgery which relieved or bypassed the pharyngeal airway obstruction; two cases are pending. Increased awareness of OSA and examination of the sleeping patient should result in earlier treatment and less morbidity for infants and children with OSA.

Adenoids↗
PubMed1981

CT diagnosis of orbital inflammation in children.

The computed tomographic (CT) examination and medical records of fourteen children with orbital inflammatory disease were analyzed to determine which signs predicted or correlated with the clinical course. The preseptal space, the orbit and the sinuses are imaged simultaneously allowing accurate definition of the extent of disease. CT signs of inflammatory disease in each of these compartments are discussed.

Adolescent↗
PubMed1981

Radiographic changes in unicameral bone cysts following direct injection of steroids: a report on 14 cases.

Twelve children (9 boys and 3 girls, ages 1 1/2-12 yrs.) with unicameral bone cysts were treated with triamcinolone acetonide (4 patients) or methylprednisolone acetate (8 patients) injected directly into the cyst cavity. Postinjection radiographic changes that indicate healing were noted in eight patients and included: reduced size of the cyst cavity, increased internal density, cortical thickening, and remodeling in the vicinity of the cyst. Additional injections were required in three patients because of delayed or partial healing. Recurrence of the cyst (1 case) was signaled by renewed rarefaction and bone expansion.

Bone Cysts↗