Donald T. Desilets

Control of flow of fetal lung fluid at the laryngeal outlet

Abstract Lambs near term with placental circulations intact were delivered by cesarean section. Cineroentgenograms of contrast material injected into the trachea demonstrated the presence of a sphincter mechanism at the laryngeal outlet. The sphincter opened periodically and allowed the lung fluid to be discharged into the nose and pharynx where it was swallowed. The mechanism consists of two large arytenoid cartilages which are held together and up against the back of the epiglottic cartilage by contraction of a muscular sling comprising thyro-arytenoid and inter-arytenoid muscles. Material injected into the nose or mouth did not enter the trachea except following occlusion of the umbilical cord. Sectioning the recurrent laryngeal nerves paralysed the muscle component of the sphincter. The mechanism probably aids in lung growth by maintaining a positive intraluminal pressure, and assists in the retention of lung surfactant. It also acts as a barrier to the ingress of mucus and amniotic fluid in utero into the future airway.

Congenital atypical benign chondroblastoma of a rib

Abstract Pathological examination of a congenital rib tumor showed a proliferating chondroid tumor with many features of a benign chondroblastoma. The site and occurrence in this age group was not described previously.

Angiographic demonstration of the ventricular septum. A new technic.

In the cardiac disease, idiopathic hypertrophic subaortic stenosis (IHSS) (1), there is hypertrophy of the myocardium which is often asymmetrically distributed. Although published descriptions appeared earlier, it was not until a clinical report by Brock (3) in 1957 and a pathologic report by Teare (10) in 1958 that the disease became well known. Since that time many other papers have appeared. The disease is much more common than was first realized. Most of the authors describing their cases emphasize that the often massive myocardial hypertrophy may primarily involve the ventricular septum (2, 4, 8, 10, 11), although usually the free wall of the left ventricle and sometimes the right ventricle are involved as well. Frequently the first manifestation of the disease is a heart murmur. The most common symptoms are dyspnea and angina. The patient is often asymptomatic, however. The electrocardiogram is almost always abnormal (2). At catheterization the demonstration of a pressure gradient within the left ve...

Transposition of the Great Vessels with Hypoplasia of the Right Ventricle

Eight cases are reported in which complete transposition of the great vessels was associated with varying degrees of hypoplasia of the right ventricle. In three, the correct diagnosis was suspected on the basis of certain electrovectorcardiographic findings and confirmed by selective angiography. Quantitative analysis of ventricular volumes and valve circumferences demonstrated that these cases represent a distinct pathological entity.The diagnosis of complete transposition with hypoplastic right ventricle may be suggested by electrocardiographic evidence of left ventricular hypertrophy, relative absence of right ventricular QRS vectors, and leftward axis for age. The vectorcardiogram reveals a counterclockwise QRS loop in the horizontal plane, situated to the left and posteriorly. These findings occur infrequently in the young infant with complete transposition.The presence of a hypoplastic right ventricle is confirmed by angiography, which demonstrates a small right ventricular chamber located centrally in the cardiac silhouette, not extending beyond the left border of the thoracic spine.

Percutaneous catheterization in children.

Despite the widespread employment of the percutaneous method of catheterization and the voluminous amount of material appearing in the literature on the subject, little has been written about this important technic in children. The vast number of percutaneous vascular examinations are performed in adults for diagnosis and evaluation of the sequelae of atherosclerosis, i.e., stenosis and thrombosis. Because these represent degenerative changes, they are seldom found in the pediatric age group. This, no doubt, is one reason there has been little emphasis on the percutaneous method of vascular entry in children. Schobinger and Ruzicka (6) in their excellent book, Vascular Roentgenology, devote an entire chapter to angiography in children. They state that the percutaneous puncture of arteries in children is difficult and the examination must be performed as a rule after a cut-down. However, Lurie et al. (5) in 1963 reported in detail their experience with the Seldinger technic and concluded that examination o...

Pelvic pneumography in the diagnosis of endocrine and gynecologic disorders in children

Diagnosis of disorders of sexual differentiation and development in children is frequently difficult and often requires exploratory laparotomy. Pelvic pneumography is a safe, simple, nonsurgical technique for outlining pelvic anatomy. In 15 patients studied, pneumography established the presence of an ovarian tumor in one of 5 children with precocious puberty, demonstrated absence of a uterus in 2 patients with amenorrhea and in one with multiple anomalies, outlined enlarged ovaries in 2 of 3 suspected cases of the Stein-Leventhal syndrome, and demonstrated normal female pelvic structures in a patient with ambiguous external genitals.

Epinephrine-Assisted Renal Venography in Renal Vein Thrombosis: Report of Two Adolescents with Nephrotic Syndrome

In adults renal vein thrombosis is caused by a variety of diseases such as peripheral phlebothrombosis, disseminated carcinomatosis, and chronic renal disease. In infants the association of severe dehydration and renal vein thrombosis is well known (1). Less well documented and understood is the relationship of renal vein thrombosis and the nephrotic syndrome in older children. We have recently studied two adolescents with steroid-resistant nephrotic syndrome in whom renal vein thrombosis was suspected clinically. Precise radiologic diagnosis in these cases was achieved, using the technic of pharmacologically assisted renal venography. The radiographic demonstration of the thrombi led to immediate surgery in one case and played an important part in the choice of therapy in the other. Case Reports Case I (R. S.): In May 1967 insidious edema developed in the lower extremities of this 16-year-old Negro boy, followed by asymptomatic hematuria. He was hospitalized and was found to be hypertensive with hypercho...

Myocardial Function from Cineangiocardiograms with a Digital Computer

Abstract An automatic computer system has been developed and programmed to scan raw, unaltered, left ventricular cineangiocardiograms and calculate the volume of each frame by an integration method. The resulting volume-time curves can be displayed on demand. Each frame is processed in about three seconds and the next frame automatically advanced. The system works well on an experimental basis, but improvements must be made in the edge-following algorithms before clinical material can be processed routinely.

Tricuspid Atresia, Transposition, and Coarctation of the Aorta

Abstract The association of tricuspid atresia, transposition of the great vessels, and coarctation of the aorta is presented in 6 cases. Resultant intractable, congestive failure, systemic hypoxia, and death in early infancy followed in each instance. The chest roentgenograms showed cardiomegaly, increased pulmonary blood flow, and pulmonary venous congestion. Once right atrial angiography confirms the presence of tricuspid atresia, left ventriculography to confirm or rule out transposition should ensue. If the great arteries are transposed, the aortic arch should be carefully studied for coarctation.

The Submentovertical Projection: A New Approach to the Study of Laryngeal and Pharyngeal Function in Infants

Abnormalities of the upper airways in newborn and small infants frequently present with confusing and poorly understood signs and symptoms. In older children and adults specialized technics such as laryngography and tomography facilitate the examination of the larynx and hypopharynx. These technics are cumbersome and often undesirable in infants. In infants, airway dynamics and deglutition have been customarily examined in the lateral position only. The conventional anteroposterior projection has been rarely used because it provides very little additional information. In searching for better technics to visualize the upper airway we found that in infants the submentovertical projection provides excellent visualization of the larynx without the necessity of extraneous contrast agents. Infants also swallow barium readily in this position. Anatomy The normal anatomy of the base of the skull and overlying soft-tissue structures in the newborn are shown in Figure 1 (2). The key osseous structures such as the m...