John A. Kirkpatrick

An improved radionuclide method for the diagnosis of gastroesophageal reflux and aspiration in children (milk scan).

A radionuclide study using technetium-99m-labelled milk feeding is described for the detection of gastroesophageal reflux and aspiration in children. A comparison of findings in 39 patients referred for both radiographic and radionuclide studies showed that barium studies were positive in 25.6% and radionuclide studies in 59% of cases, reflecting the sensitivity of the radionuclide technique. This technique is also physiological and allows prolonged patient monitoring. It is simple to perform and should prove useful in the evaluation of patients suspected of having gastroesophageal reflux and aspiration.

Lymphoid Hyperplasia of the Colon in Children: Roentgen Observations

Lymphoid hyperplasia of the colon has been identified in aircontrast studies of the colon in 19 infants and children, the majority of whom presented with rectal bleeding. In each, multiple umbilicated polypoid lesions have been observed. Umbilication in multiple polyps in the colon appears to be diagnostic of lymphoid hyperplasia and differentiates it from juvenile and other polyps in children. This benign lesion probably represents the normal response of lymphoid tissue in children to a variety of stimuli. There is no evidence that the rectal bleeding is caused by the lymphoid hyperplasia.

Madelung's Deformity: Observations in 17 Patients

IN 1878, MADELUNG (8) described a painful abnormality of the wrist and forearm which characteristically began in adolescence. The radiographic alterations of the radius and ulna were described later. The most complete review of the subject is that of Anton et al. (1), who collected and summarized the literature through 1938. Considering this clinical and radiographic abnormality a deformity rather than a syndrome, these workers distinguished it from Madelungs disease, which is characterized by diffuse symmetrical lipomatosis of the upper part of the back, shoulders, and neck. They also suggested that the deformity of the wrist and forearm be considered a dyschondroplasia of the distal radial epiphysis. While this may be a logical name for the entity, it has not found wide usage, Madelungs deformity remaining the preferred term. In 1929, Leri and Weill (7) reported a case of dwarfism and radiographic alterations of the forearm and wrist similar to Madelungs deformity, although no reference was made to M...

Obstructions of the Upper Airway in Children as Reflected on the Chest Radiograph

Abstract Alterations in the appearance of the heart and lungs that should lead one to suspect the possibility of upper airway obstruction in children are: distension of the hypopharynx, underaeration of the lungs, cardiac enlargement, cardiac enlargement with passive congestion, and pulmonary edema without cardiac enlargement.

Immune deficiency syndromes.

S INCE 1952, following Bruton’s report of a patient with agammaglobulinemia,’ efforts have been made to gain insight into the complexities of the immune system. The growing list of recognizable immunodeficiency states is a testimonial to the achievements reached that established the importance of the immune system in protecting the individual against infections and the development of certain neoplasms.6 The lymphocytes, the phagocytic cells of the blood, and reticuloendothelial system, comprise the major components of an active and complete immune system. Because the thymus is now known to play a major role in the ultimate activation of the lymphocyte, a consideration of its role in normal function must precede the discussion of the various abnormal states.

The Lateral Decubitus Film

Abstract The lateral decubitus chest film is helpful and convenient in detecting air trapped in infants and young children of whom satisfactory expiration chest films are difficult to obtain.

Nasopharyngeal Lymphoid Tissue Roentgen Observations in 257 Children Two Years of Age or Less

Abstract Lateral radiographs of the nasopharynx in 257 children two years of age or less were evaluated to determine the age at which lymphoid tissue in the posterior nasopharynx becomes visible radiographically. Soft tissue was observed in the nasopharynx in all infants over six months old but in only half of those under six months. In no infant less than one month old was a soft-tissue mass seen in the posterior nasopharynx on lateral films of that area. These findings suggest that in children over six months of age, absence of this lymphoid tissue may be significant and imply an immune deficiency; its absence in infants under six months may be normal.

Widening of the Cranial Sutures: A Roentgen Observation During Periods of Accelerated Growth in Patients Treated for Deprivation Dwarfism

An increase in the width of the cranial sutures is a common manifestation of increased intracranial pressure in infants and children. However, separation of the sutures has been observed during treatment for “failure to thrive” in three children who had no signs or symptoms of increased intracranial pressure. The clinical evaluation and course of each patient fulfilled the diagnostic criteria outlined by Barbero and Shaheen for the clinical syndrome of growth failure not secondary to organic causes (1). While in the hospital, the patients responded rapidly to emotional support and proper nutrition. Marked acceleration in growth and social and emotional development occurred during their hospital stay, and at this time the cranial sutures were noted radiographically to widen. Deprivation dwarfism or emotional failure to thrive occurs in children who have experienced emotional and psychological deprivation (4). As described by Barbero and Shaheen, the syndrome is characterized by: “(1) weight below the 3rd p...

Krypton-81m: a better radiopharmaceutical for assessment of regional lung function in children.

Krypton-81m, an inert, radioactive gas with a physical half-life of 13 seconds was used to evaluate regional lung ventilation in 25 pediatric patients. The results suggest that Kr-81m has several advantages over previous methods employing xenon-133. These include: more favorable physical characteristics for imaging with present scintillation cameras; ease of performance of the examinations; improved resolution and multiple views with better detection and localization of abnormalities; and a much lower dose to the patient.

Early neonatal pneumoperitoneum from progressive massive tension pneumomediastinum.

Three cases of early neonatal pneumoperitoneum as a result of progressive massive tension pneumomediastinum are described. The important roentgenographic features include massive pneumomediastinum located both above and behind the heart, absence of free peritoneal fluid, pneumothorax, and air in the stomach. Laparotomy should be avoided in this condition.