Charles A. Gooding

Meningiomas of childhood and adolescence

Review of clinical, roentgenographic, and histologic material of 75 purported meningiomas in patients younger than 20 years old revealed 48 cases that we considered clearly to represent meningiomas. The meningiomas were characterized by posterior fossa location (19 per cent), intraventricular location (17 per cent), roentgenographic evidence of tumor calcification (32 per cent), and frequent association with neurofibromatosis (23 per cent). These findings are contrasted with those of the adult population.

Pneumonitis following inclusion blennorrhea

A pregnant woman and her husband had proved chlamydial genital tract infections. She gave birth to a male infant who developed inclusion blennorrhea (inclusion conjunctivitis of the newborn infant). While on topical chemotherapy for his eye disease, the infant developed pneumonitis. Chlamydiae were recovered from his sputum at a time when conjunctival specimens were sterile. This finding raises the possibility that the agent of inclusion conjunctivitis may cause systemic infections in neonates exposed during passage through an infected birth canal.

An Experimental Model for the Study of Meconium Aspiration of the Newborn

Abstract Experiments leading to the development of a model to study meconium aspiration of the newborn are described. The final model consisted of the undelivered progeny of a hysterotomized pregnant dog under spinal anesthetic. The puppies were subjected to tracheal intubation and meconium injection before clamping of their umbilical cords. This model may be used to provide objective evidence of the value of parenteral steroid administration in instances of meconium aspiration in the newborn.

Roentgenographic Analysis of Meconium Aspiration of the Newborn

Abstract Eighty infants were delivered through meconium-stained amniotic fluid. In 40% of the 75 infants whose chest roentgenograms were obtained in the first hour of life, focal or generalized areas of diminished aeration were seen. Air-trapping was not observed, but in 9.3% of the infants pneumothorax or pneumomediastinum was present or developed later. Pleural effusion was evident at the costophrenic sulci in 27% of those infants in whom consolidation was manifested.

Left paraduodenal hernia leading to ileal obstruction

Left paraduodenal hernias are a rare cause of abdominal pain or obstruction. However, because there is high associated mortality (20 %), prompt and accurate diagnosis is essential. Because internal hernias are not detectable on physical examination, imaging is relied upon for pre-operative diagnosis. Although both computed tomography and barium studies demonstrate left paraduodenal hernias as a cluster of bowel located posterior to the stomach and to the left of the distal duodenum with absence of the normal interdigitation between loops, the findings may be subtle. Knowledge of these findings can avoid an unnecessary delay in diagnosis. We present the case of a 15-year-old girl with a left paraduodenal hernia, where initial CT and barium studies demonstrated nonobstructed jejunum within the hernia sac. Two weeks later a repeat study showed obstructed distal ileum, rather than proximal jejunum, within the sac.

Compression of Superior Sagittal Sinus by Neonatal Calvarial Molding

Compression of the superior sagittal sinus may result from overlapping of the parietal and occipital bones in the newborn infant. Such compression has been documented angiographically and the resultant decreased blood flow confirmed with a Doppler ultrasound probe. This compression may increase intracerebral venous pressures and thereby contribute to the high incidence of intracerebral hemorrhage in premature infants with respiratory distress syndrome.

Pediatric liver tumors – a pictorial review

Hepatic masses constitute about 5–6% of all intra-abdominal masses in children. The majority of liver tumors in children are malignant; these malignant liver tumors constitute the third most common intra-abdominal malignancy in the pediatric age group after Wilms’ tumor and neuroblastoma. Only about one third of the liver tumors are benign. A differential diagnosis of liver tumors in children can be obtained based on the age of the child, clinical information (in particular AFP) and imaging characteristics. The purpose of this review is to report typical clinical and imaging characteristics of benign and malignant primary liver tumors in children.

A model for the cinefluoroscopic and manometric study of chronic intestinal obstruction

NFANTS BORN WITH INTESTINAL atresia have considerable dilatation of the bowel proximal to the obstruction, and the distal bowel is collapsed. When the dilated proximal intestine is anastomosed to the distal bowel, persistent functional obstruction occurs even though the anastomosis is widely patent. Contrast roentgenograms show abnormal peristalsis with a churning, to-and-fro, flow of contrast medium which is not propelled beyond the dilated part. This functional obstruction of the bowel is the most common cause of death in infants treated for jejunal atresia.’ Many investigators have studied the physiology of normal intestinal motility in the human by measuring changes in intraluminal pressure and by roentgenographic techniques. An historical summary of these methods is recorded by Hightower.’ In the small bowel, two types of intestinal contraction have been described which were derived from a correlation between intraluminal pressure changes and cinefluoroscopic observations. Type I waves are simple monophasic increases in pressure lasting less than 8 set with an amplitude of 13~ 60 cm of water pressure. These waves have been associated with eccentric contractions of the bowel wall which travel less than a few centimeters, and seem to have a mixing action on the intestinal contents. Type I waves account for 85”,, to 90”, of the wave activity in the intestine. Type III waves have a complex pattern characterized by a prolonged elevation above baseline pressure, on which are superimposed monophasic spikes similar to, but shorter in duration than Type I waves. Type III waves have been correlated with concentric contractions of the intestine which travel along the bowel wall and propel luminal contents aborally. These waves may occur every 10 set to 8 min, and have an amplitude of 5- to 30-cm water pressure. We have attempted to clarify the physiologic changes in intestinal motility after chronic small bowel obstruction. We wanted an experimental model which might be comparable to intestinal atresia, and which could be evaluated by radiologic and manometric studies. The intestinal obstruction would have to exist for several weeks or months without producing fluid or electrolyte de

AUR memorial Award. Induced alignment of flowing sickle erythrocytes in a magnetic field. A preliminary report.

Deoxygenated sickle erythrocytes in static suspension align perpendicular to a magnetic field. To assess the importance of this observation to MRI of sickle-cell disease, an in vitro flow apparatus was devised and the orientation of sickle erythrocytes flowing through a 0.38 T magnetic field was investigated. We showed a significant perpendicular alignment of fully deoxygenated sickle erythrocytes flowing at 3 to 4 mm/minute (P less than .001). These results suggest that deoxygenated erythrocytes in a sickle-cell patient could orient perpendicular to a magnetic field, and therefore that MRI of such patients could possibly result in worsening of vaso-occlusive complications. Further studies are needed to assess the possible hazards of MRI of sickle-cell disease, especially at high field strengths.

Role of MRI in the valuation of ambiguous genitalia

Diagnostic accuracy of magnetic resonance imaging (MRI) interpretation was assessed prospectively in patients with ambiguous genitalia or intersex problems. MRI depiction of the uterus was possible in 93%, the vagina in 95%, the penis in 100%, the testis in 88%, and the ovary in 74% of patients. The strength of MRI lies in the multiplanar capability and tissue characterization by means of T1- and T2-weighted sequences. MRI contributes to accurate morphologic evaluation of müllerian duct structures, the gonads, and the development of the phallus, all of which are essential for appropriate gender assignment and planning of surgical reconstruction.