Frederic N. Silverman

Neoplasia Following Therapeutic Irradiation for Benign Conditions In Childhood

The question of whether or not radiation can be indicted as the principal causative factor in the induction of neoplasia following radiation exposure for either diagnostic or therapeutic purposes has been of increasing interest over the past several years (4, 12, 18, 19, 20). The present investigation was initiated in 1956, in the Cincinnati area, which appeared to offer abundant material for evaluation. The first case of x-irradiation for treatment of “enlarged thymus” was reported from Cincinnati by Friedlander in 1907 (8), and both roentgen diagnosis and therapy of thymic enlargement enjoyed considerable local popularity until recently. Observations from this city were published by Lange in 1914 (11). Since the majority of patients in the series to be reported here were from a group of private and municipal hospitals, none of which is particularly noted as a cancer center, the possibility of bias being introduced by selection of a neoplasia-prone population was thought to be minimal. Historical Review ...

Orbital hypotelorism, arhinencephaly, and trigonocephaly.

Roentgenographic examination of the skull in frontal projection provides, among other information, an opportunity to evaluate the distance between the orbits. An increased interorbital distance is a characteristic feature of ocular hypertelorism or Greigs disease (8). A decrease in this cranial dimension, which properly may be termed orbital hypotelorism, is found in arhinencephaly and in trigonocephaly. In this paper, the normal range of the interorbital distance in infants and children, as determined in a series of skull roentgenograms, will be presented, and two illustrative instances of orbital hypotelorism will be reported: the first patient was affected by arhinencephaly, the second by simple trigonocephaly. The subjects of orbital hypotelorism, arhinencephaly, and trigonocephaly and the relations which exist among these three malformations will be reviewed. Case Reports Case I (Fig. 1): A white female infant was admitted to the hospital at two and a half months of age for repair of “harelip and cl...

Unrecognized trauma in infants, the battered child syndrome, and the syndrome of Ambroise Tardieu. Rigler Lecture

Abstract A brief account of the history of child abuse as a social and legal concept is followed by a presentation of the clinical and radiographic findings in the abused child. Frequently, cutaneous lesions, ocular lesions, and mucosal lesions are seen in a child who shows signs of malnutrition and fear. Radiographically, a variety of skeletal findings, including new fractures, healing fractures, and increase in bone density are seen. Extraskeletal findings such as lung contusions, duodenal, mesenteric, and jejunal changes, and retroperitoneal hematoma are seen. The role of radiologists in recognizing abuse of a child and directing referring physicians to available social and legal facilities is emphasized

Premature Obliteration of the Sternal Sutures and Pigeon-Breast Deformity

The purpose of this paper is to illustrate an uncommon and little known developmental anomaly of the sternum characterized by premature obliteration of its sutures and by a tendency toward forward angulation. Associated with this angulation is an increase in the sagittal diameter of the thorax of the type seen in “arcuate pigeon breast.” Case Reports Case I: A white male child had been under observation since birth for congenital micrognathia of mild degree, bilateral clubfoot, inguinal hernia, and cryptorchidism. A “pigeon-breast” deformity had also been present since early infancy. When last seen at four years, he appeared well developed, both physically and mentally; the deformity of the feet had improved considerably, the micrognathia only slightly. The childs head was elongated, but there was no roentgen evidence of premature craniosynostosis. The thorax showed a midline bulge, anteriorly (Fig. 1). The lateral roentgenograms of the chest taken at one and at four years are reproduced in Figures 2 and...

Congenital Insensitivity to Pain: A Neurologic Syndrome with Bizarre Skeletal Lesions

The reactions of bone to trauma are well known; even when the traumatic episodes have been unrecognized, forgotten or denied, the evidence provided by roentgenographic examination of the skeleton frequently permits unequivocal diagnosis and subsequently elicits the confirmatory history (4, 26, 28). Thus, custodians of children may be made objectively aware of the fact that certain activities can be traumatic for their charges. In rare instances, failure to recognize a traumatic basis for bizarre roentgenographic appearances of bones results from subjective rather than objective deficiencies; the patient and not his custodian is, in effect, unaware of the trauma. Unawareness of trauma associated with a congenital indifference or insensitivity to pain was responsible for the unusual skeletal lesions observed in the two sisters reported below. No satisfactory explanation for the clinical and radiographic findings was available until we learned of the syndrome through Murrays report (21) eight years after ou...

Calcification of the intervertebral disks in childhood.

Calcification of the intervertebral disks generally has been considered a degenerative disease of adults. Schmorl (19), whose extensive studies on this subject are recognized as fundamental, believed disk calcification to be a degenerative process of no clinical significance. It was described more recently, by de Lorimier (6) only in relation to “senescent spinal osteoarthropathy.” Other investigators, however, have discovered radiographically demonstrable calcification of the disks in association with local clinical symptoms (1, 11, 13, 18, 23) and with systemic disease (I 6). Calcification of the intervertebral disks is said to be very uncommon in children. Cohen and his associates (4), in 1949, could find only 6 earlier case reports. These included the case of Weens (23) and 5 cases from the foreign literature abstracted in his report. In all of these 6 cases there were clinical signs referable to the areas in which calcification was observed. A similar case, in an eleven-year old girl, is included in ...

Treatment of Leukemia and Allied Disorders with Folic Acid Antagonists; Effect of Aminopterin on Skeletal Lesions

The term “chemotherapy” was introduced by Ehrlich to indicate the treatment of parasitic disease by direct chemical attack upon invading organisms. More precisely, the goal of chemotherapy has been defined as the killing of pathogenic forms of life with a minimum of effect upon the tissues and physiologic processes of the host (6). In a restricted sense, chemotherapy is directed against pathogenic organisms—viruses, fungi, bacteria, spirochetes, protozoa, and helminths. If the words “parasitic disease” in the definition above are interpreted broadly, we can add to the list of chemotherapeutic agents those substances used in the treatment of neoplastic disease. The basic goal of affecting the “parasite” with a minimum of effect upon the host is not lost. Many so-called carcinolytic agents have been described and used. These have included the products of micro-organisms (toxins, polysaccharide extracts, etc.), immunologic preparations (antireticular cytotoxic serum), hormones, and various chemicals (urethan...

Ureteroceles in children, with emphasis on the frequency of ectopic ureteroceles.

The most common type of ureterocele in infants and children is an intravesical and intraurethral protrusion of a dilated ureter which passes submucosally in the vesical wall before ending ectopically in the urethra. Termed an ectopic ureterocele, it differs significantly in pathologic anatomy from the better known simple ureterocele. The latter characteristically occurs in the adult and consists of an intravesical cystic expansion of a ureter immediately proximal to its opening in the urinary bladder. In general, ectopic ureteroceles are much larger than simple ureteroceles, have a different location within the bladder, cause more severe symptoms, and have a less favorable prognosis. Since most of them produce a recognizable pattern on excretory urography, it is important that both the radiologist and the urologist be familiar with their pathologic anatomy. To Ericsson (1954) belongs the credit for first drawing attention to the pathologic anatomy and frequency of ectopic ureteroceles (1), although he was...

Congenital obstructions of the alimentary tract in infants and children; errors of rotation of the midgut.

Roentgen examination of the alimentary tract in infants and children has its greatest application in the diagnosis of obstruction. Most obstructions are related to faulty embryonic development; the signs may appear during the neonatal period or later in childhood. In a panel discussion on Intestinal Obstruction in Infancy at a meeting of the American Academy of Pediatrics in 1941, Gross (4) listed approximately 2,000 cases seen at the Boston Childrens Hospital in the preceding twenty years. Almost 1,300 cases were congenital in origin, an incidence of 2 to 1 with reference to acquired obstruction. Motor activity of the alimentary tract begins long before birth. In a study of intra-uterine respiration (1), thorotrast was injected into the amniotic cavity of pregnant women prior to therapeutic abortion. After delivery, roentgen examination showed opaque material distributed through the alimentary tract of the fetus. There was no evidence of defecation of the thorotrast ingested in utero. The demonstration ...

Gastroesophageal Incompetence, Partial Intrathoracic Stomach, and Vomiting in Infancy

In 1947, Neuhauser and Berenberg (22) described the mechanism for some cases of persistent vomiting in infancy under the term cardioesophageal relaxation or chalasia. The free flow of a barium mixture between the stomach and the persistently dilated esophagus, under the influence of position and gravity (Fig. 1), was attributed to temporary neuromuscular dysfunction involving the diaphragm and the intrinsic gastroesophageal musculature. Local disease in the region of the gastroesophageal junction or in the central nervous system was believed to account for some cases. The condition was to be differentiated from “congenital short esophagus” and partial intrathoracic stomach due to diaphragmatic hernia; prompt and gratifying cessation of symptoms was said to occur if the infant was maintained in an erect position. This postural treatment impeded reflux of gastric contents into the esophagus, and within three to four weeks clinical and radiologic recovery took place. Subsequently, English observers (2, 6), a...