Gary D. Shackelford

Complications Associated with Cystography in Children

Complications of cystography include infections, especially those associated with intrarenal reflux; complications related to bladder filling; allergic reactions; catheter problems; inflammatory response of the bladder to contrast media; peritoneal spillage of contrast medium via the vagina; transurethral reflux of organisms from cleansing procedures; pain from reflux or incorrect catheter placement; radiation effects; temporary anuria; and intrarenal foreign body reaction to contrast media. Fourteen cases are presented, including two patients who died from sepsis. Some considerations for reduction of the complications are discussed.

Esophageal Replacement with Colon in Children: Functional Results and Long-term Growth

Twenty-three children consecutively undergoing colon interposition for esophageal replacement were evaluated with barium swallows, clinical interviews, and questionnaires. Fourteen patients underwent colon interposition because of caustic burns of the esophagus only or of the hypopharynx and esophagus. Nine children had long-segment esophageal atresia or esophageal atresia with tracheoesophageal fistula and are included in our operative group. The mean follow-up was 12.8 years for all patients. Strictures, leaks, and colon ischemia at the proximal anastomosis represent the major morbidity for the operative procedure. Analysis of growth charts reveals that patients who ingest lye tend to remain in the 50th percentile after colon transplant, while patients with esophageal atresia or tracheoesophageal fistula who had been in the 12th percentile preoperatively improved to the 33rd percentile after successful transplantation. Radiographic examinations, functional results, and growth curves demonstrated excellent results in 20 patients. Although the choice of a conduit for esophageal replacement is controversial, the surgeon can expect good long-term function and growth with the use of colon in children.

Diagnosis of congenital absence of left pericardium by MR imaging.

Congenital absence of the pericardium, whether partial or total, is a rare abnormality. It can be very difficult to diagnose clinically as well as to confirm radiographically. Plain film fluoroscopy and CT have been shown to be of value in differentiating this entity from others with similar findings. We report a case in which magnetic resonance was utilized to confirm the diagnosis and the findings of this new technique are described.

Prepyloric gastric antral web: a puzzling epidemic.

Antral webs and diaphragms are considered a rare cause of gastric outlet obstruction in infants and children. A radiographic diagnosis of antral web was made in 28 children during a 26-mo period. Nonbilious, often projectile vomiting was the predominant presenting symptom in 24 infants who were less than 6 mo of age. The older children complained of pain, vomiting, fullness after eating, and eructation. The characteristic radiologic finging was a wirelike transverse septum 1--2 cm proximal to the pylorus. Poor antral filling was an important early clue in the radiographic search for the webs. Pyloroplasty was performed in 20 patients, frequently after failure of medical management of symptoms. Coexistent congenital abnormalities were present in 28% of patients. A search for environmental and familial factors has failed to elucidate any teratogenic influences in this population.

Neonatal Hepatic Calcification Secondary to Transplacental Infection

Transplacentally acquired infections which cause prenatal and neonatal hepatitis can cause hepatic calcification in the newborn. Three cases are reported in which congenital toxoplasmosis and herpes simplex viral infections were causes of neonatal hepatic calcification. Autopsies performed in 2 of the cases revealed extensive dystrophic hepatic calcifications.

The Use of a Foley Catheter for Removal of Blunt Esophageal Foreign Bodies from Children

A technique of extracting blunt esophageal foreign bodies from children with the aid of an inflated Foley catheter balloon is described. This method provides an alternative to esophagoscopy in patients without underlying esophageal disease.

Cartilaginous Esophageal Ring: A Cause of Esophageal Stenosis in Infants and Children

A cartilaginous ring associated with other tracheobronchial remnants is a rare cause of distal esophageal stenosis. Although the symptoms are nonspecific, a radiographic finding of linear intramural clefts projecting from the area of stenosis is distinctive. Pathological correlation has shown that these clefts represent communicating intramural cystic spaces lined by respiratory epithelium. Resistance to instrumental dilatation and the absence of inflammatory mucosal changes are characteristic endoscopic findings.

Sonographically detectable cysts in polycystic kidney disease in newborn and young infants

Autosomal dominant (adult type) and autosomal recessive (infantile type) polycystic kidney disease are 2 distinct forms of hereditary cystic renal disease with differing pathologic and clinical features. Glomerulocystic kidney disease is probably a separate entity, whose pathologic features may closely resemble those of autosomal dominant polycystic kidney disease, especially in small infants. An example of each of these conditions in a small infant is presented, all of which had sonographically detectable cysts. Pathologic correlation was available in each case. While there are typical sonographic features of autosomal dominant and autosomal recessive polycystic kidney disease in newborn and young infants, there is no specific appearance of either condition, and glomerulocystic kidney disease can apparently resemble either one. Other investigations, particularly family studies and pathologic verification, are important in order to establish the correct diagnosis.

Intergluteal Dorsal Dermal Sinuses The Role of Neonatal Spinal Sonography

are frequently associated with bacterial meningitis, aseptic meningitis, low tethered cord, spinal dermoids, teratomas, epidermoids, and intraspinal abscesses.2Intergluteal dorsal dermal sinuses are the most common type of dorsal dermal sinus and are frequently referred to as sacral sinuses, sacral dimples, or pilonidal sinuses.’ Although the risk of tethered cord and intraspinal extension in patients with intergluteal dorsal dermal sinuses is considered small infants with intergluteal lesions are often referred for spinal sonography. We reviewed our experience with neonatal spinal ultrasound to assess its role in the

spectrum of sonographic findings in infantile polycystic kidney disease with urographic and clinical correlations

We evaluated nine patients, age 1 day to 17 years, having infantile polycystic kidney disease (IPKD). Using modern scanners with 5‐MHz transducers we have observed two previously unemphasized sonographic (US) findings, a peripheral zone of normally echogenic cortex (five patients), and mild caliectasis (two patients). Our data suggest that IPKD is a more heterogeneous condition clinically and sonographically than generally appreciated and that presence of a thick normally echogenic renal cortex is a good predictor of concurrent normal renal function and prolonged survival.