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Biomedical subjects

S S Kramer

Publications and source records attributed to S S Kramer.

At least 55 records · Page 3Linked to original sources
PubMed1985

Transverse esophageal folds: association with corrosive injury.

Two cases are presented in which transverse esophageal folds were observed in children following ingestion of corrosive material. Strictures developed at the sites that initially manifested this serrated mucosal appearance. These findings lend additional credence to the concept that transverse folds, reflecting contractions of the muscularis mucosae, represent a pattern of pathologic motility rather than merely a variant of normal mucosal anatomy.

Burns, Chemical↗
PubMed1985

Pulmonary manifestations of juvenile laryngotracheal papillomatosis.

Juvenile laryngotracheal papillomatosis spreads to involve the lungs in less than 1% of cases, and when this occurs, the prognosis is poor. In seven such cases, the lung lesions, which appeared either solid or cystic on radiographs, proved to be benign squamous cell proliferations or papillomas, with central cavities containing debris or air. They seemed to grow centrifugally, using the alveolar walls as scaffolding with central coalescence and lung destruction. Papillomas spread inferiorly from the larynx by direct extension as far as the major bronchi, but rarely beyond. However, the parenchymal lesions were widely scattered, and some were subpleural. This discrepancy suggests that fragments become detached, particularly during endoscopic resection, and are carried down the airways by airflow. Those that lodge proximal to the respiratory bronchioles may be removed by mucociliary action and cough. Those that travel more distally are poorly cleared and may grow. If enough lung parenchyma is destroyed, the patient can develop symptoms of restrictive lung disease in addition to signs of upper airway obstruction.

Adolescent↗
PubMed1983

Comparison between x-ray and bone scan detection of bone metastases in patients with rhabdomyosarcoma.

A comparison of radiographic and 99mTechnetium methyldiphosphonate scintigraphic evaluations for extent of skeletal disease was made retrospectively in 17 pediatric patients with Group III and IV rhabdomyosarcoma. Thirteen children had evidence of skeletal metastases. Of these, four exhibited multiple sites of blastic as well as lytic skeletal involvement on x-rays that were not detected by bone scans: two at the time of initial diagnosis, and two at relapse in children with prior radiotherapy to involved bones. In three additional patients a greater extent of bony disease was evident on x-rays than on bone scan. Neither the pathology of the tumor, lytic versus blastic quality of the bone lesion, nor lesion size per se was found to correlate with the failure to detect them on the bone scan. Although bone scans have greater sensitivity than x-rays for the detection of metastatic bone involvement in several adult and pediatric neoplasms, in the case of rhabdomyosarcoma, the radiographic exam appears to be a more sensitive indicator in some patients and should be considered an essential study in the evaluation of skeletal involvement by this tumor.

Bone Neoplasms↗
PubMed1983

CT demonstration of the phrenic nerve.

Twenty-four consecutive patients examined with whole lung computed tomography (CT) using a high resolution scanner were evaluated for detection of the phrenic nerve. The phrenic nerve was considered to be demonstrable when a 1-3 mm rounded structure was identified adjacent to the pericardium on at least two contiguous sections. The phrenic nerve was thus indicated in 13 patients, eight children and five adults. The nerve was found on the left side in 11 patients, the right side in one patient, and bilaterally in one patient. It is important to recognize the normal course of the phrenic nerve on CT in patients being evaluated for pulmonary metastases.

Adolescent↗
PubMed1981

Lethal chylothoraces due to superior vena caval thrombosis in infants.

An unusual etiology, probably iatrogenic, for chylothoraces in the newborn period was recently noted. Three tiny premature infants, all of whom subsequently died, developed massive bilateral chylothoraces. These infants had had prolonged hyperalimentation using jugular central venous catheters for severe gastrointestinal problems and malnutrition. All developed superior vena caval thrombosis, two with overt superior vena caval syndromes. Two had venograms that showed extension of thrombus into the innominate veins to the confluence of the jugular and subclavian veins, at the site of drainage of the lymphatic channels of the thorax. The relationship between superior vena caval an innominate vein thrombosis and chylothoraces in discussed and an important pitfall in the radiologic evaluation is emphasized.

Chylothorax↗
PubMed1979

The pediatric tracheostomy: simple roentgen studies of morphology and function.

Following tracheostomy, simple roentgen studies coordinated with decannulation permit accurate evaluation of the pediatric patient. These studies require alertness to the child's clinical condition as well as a selective, monitored roentgen technique. The conventional lateral neck radiograph and the high-kV frontal tracheogram complete the evaluation in most cases. Fluoroscopy and xerography can be of additional value if decannulation is difficult, though xerography should be used only to confirm the presence of a granuloma seen on the conventional radiograph.

Airway Obstruction↗
PubMed1978

N-type anorectal malformations.

Three cases of N-type anorectal malformations have been encountered. Two girls with anorectal-vestibular fistulas (one with a normal anus and the other with mild stenosis) were typical of 15 other such cases in the literature. A boy with an anorectal-urethral fistula and covered anus had a lesser variant than most of the other 8 males in the literature. The frequently accompanying esophageal, renal, and skeletal anomalies were not present, nor did he have anterior urethral hypoplasia. The constellation of other major associated anomalies in the boys, but not in the girls, follows the pattern of other types of anorectal malformations and suggests an earlier and/or more severe teratogenic insult in the boys. Anterior perineal resection of the fistula is appropriate for girls with N-type fistulas and for those boys with normal anterior urethras. An additional urethroplasty is necessary for boys with anterior urethral hypoplasia. Our experience and that from the literature suggest that N-type anorectal malformations constitute a rare but real entity, akin to N-type tracheoesophageal fistulas. A plea is made that they be included in classifications of anorectal anomalies.

Anal Canal↗
PubMed1978

Pediatric tracheostomy. I. Radiographic features of normal healing.

Serial radiographic studies were used in a prospective study of tracheostomy healing in 30 consecutive infants and children. The examinations were simple, required no anesthesia or sedation, and were coordinated with decannulation of the tracheostomy. In 22 of 30, the tracheostomy site healed normally; in four of these 22 patients the primary cause for obstruction persisted. In 19 of 22 the radiologic study served as an alternative to bronchoscopy before decannulation. Particularly in small infants, the features of normal healing vary in the first days; temporary narrowing of the tracheal lumen can occur at the stomal site and mimic early granulations. After 1 month the trachea is normal except for minor changes at the previous site of the tracheostomy.

Bronchoscopy↗
PubMed1978

Pediatric tracheostomy. II. Radiographic features of difficult decannulations.

A difficult decannulation was the principal complication in 12 of 30 consecutive infants and children with tracheostomies. Simple radiographic studies permitted accurate diagnoses which correlated with bronchoscopy. In eight patients an endotracheal lesion was caused directly by the tracheostomy, a risk of complication higher than expected. These obstructions were usually granulomas at the superior margin of the stoma; resectable and nonresectable granulomas could not be differentiated radiographically. Four patients had a primary tracheal or laryngeal obstruction which preceded the tracheostomy and complicated decannulation; these included adhesions of the vocal cords and subglottic trachea and posed difficulties in radiographic diagnosis. In no case was dependency on tracheostomy entirely due to emotional causes.

Bronchoscopy↗
PubMed1977

Neonatal intussusception. Report of 12 cases.

Twelve cases of neonatal intussusception are presented and another 25 taken from the literature are reviewed. Intussusception in the first month of life is a distinct clinical and pathological entity, presenting as bowel obstruction in the first days and usually led by a tumor. In the past, a high mortality rate has been related to late diagnosis. The barium-enema examination is diagnostic.

Female↗
PubMed1976

A useful radiologic sign for the diagnosis of Turner's syndrome.

A new X-ray sign of gonadal dysgenesis is described. In this series nine out of ten patients with Turner's syndrome have a coarse, reticular pattern of the carpal bones. A comparison with other previously described roentgenographic characteristics on hand and wrist films of these children leads to the conclusion that the new sign is more reliable and specific.

Adolescent↗
PubMedDate not supplied

Vascular rings and their effect on tracheal geometry.

The major clinical impact of vascular rings in children is tracheal compression, which presents with recurrent symptoms of stridor, noisy breathing, and wheezing. This study tests the hypothesis that symptomatic patients have altered tracheal geometry compared to nonsymptomatic individuals. We retrospectively reviewed the tracheal dimensions (area and longest and shortest diameters) as visualized by magnetic resonance imaging from the cupola of the lung to the carina of 49 patients referred for evaluation of a vascular ring. The smallest dimension relative to the largest dimension (% of maximum) and the coefficient of variation (CoVar; standard deviation/mean) were assessed for each parameter. In all parameters measured (area and longest and shortest diameters), patients with symptoms due to vascular rings had significantly different values than patients without symptoms. The % of maximum was significantly smaller (area, 48.6 vs 62.1%; longest diameter, 41.0 vs 54.0%; shortest diameter, 45.0 vs 56.5%) and the CoVar was significantly greater (area, 0.26 vs 0.18; longest diameter, 0.31 vs 0.22; shortest diameter, 0.28 vs 0.19) in symptomatic individuals than in nonsymptomatic individuals. Patients with vascular rings who are symptomatic have significantly altered tracheal geometry compared to nonsymptomatic individuals. Magnetic resonance imaging is a useful tool for visualizing both the cardiovascular and the tracheal anatomy in patients with vascular rings and provides useful information for the management and care of these patients.

Aorta, Thoracic↗