John Pereira

The radiologist says malrotation: does the surgeon operate?

Abstract The management of malrotation when it is an incidental finding is unclear. This retrospective study reports an analysis of radiological and operative findings in a series of 71 patients. There were no deaths. We report a false-positive rate of 15% for upper gastrointestinal contrast studies reported as showing malrotation. Our findings and a review of the literature demonstrate that in the asymptomatic child over 2 years of age, the evidence supporting mandatory correction of malrotation is weak.

ILAE‐Defined Epilepsy Syndromes in Children: Correlation with Quantitative MRI

Summary: Purpose: The role of quantitative magnetic resonance imaging (MRI) in evaluation of childhood epilepsy remains poorly defined, with minimal published data. Previous work from our center questioned the specificity of hippocampal asymmetry (HA) in an outpatient group whose epilepsy was defined by using clinical and interictal data only. By using childhood volunteer controls and defining epilepsy syndromes using video‐EEG monitoring, we readdressed the utility of HA in differentiating mesial temporal lobe epilepsy (Mtle) from other partial and generalized epileptic syndromes in children.

Renal biopsy in children: comparison of two techniques

Two hundred and thirty-five children who underwent percutaneous renal biopsy under real-time ultrasound guidance at The Hospital for Sick Children, between 1 January 1991 and 31 March 1993, were studied to compare the incidence of complications after biopsies with the Trucut needle (TN) and the Bard Biopty gun (BG). Of the 190 cases for which full clinical details were available and in which a single instrument was used for renal biopsy, 157 were biopsied with the BG and 33 with the TN. There was no significant difference between the two groups in variables such as age, weight, sex, number of needle passes and number of tissue cores obtained. The proportion of native and allograft biopsies in each group was similar. More children in the TN group underwent biopsy under general anaesthesia. Adequate diagnostic tissue samples were obtained in 189 of 190 cases. There were more complications in the TN group than in the BG group (P<0.001). When allograft and native kidney biopsies were analysed separately, this difference in complications remained highly significant for the native kidney group (P<0.005), though not for the allograft group. When the effect of needle size alone was investigated, there was no significant difference in the incidence of complications when TN biopsies were compared with 14-gauge BG biopsies or when 14- and 18-gauge BG biopsies were compared with each other.

Venous malformations: Clinical course and management of vascular birthmark clinic cases.

Venous malformations (VM) are an uncommon vascular malformation with an estimated incidence of 1–2 per 10 000 births. The aim was to define the clinical characteristics and management of children with VM and develop a database for future research.

Investigation of suspected Guillain–Barre syndrome in childhood: What is the role for gadolinium enhanced magnetic resonance imaging of the spine?

Aim:  To review the role of gadolinium‐enhanced magnetic resonance imaging of the spine in the diagnosis of paediatric Guillain–Barre syndrome and compare it with nerve conduction studies and cerebrospinal fluid analysis.

Radiological input during paediatric multidisciplinary team meetings and its influence on clinical patient management.

There is little information about the role of the radiologist at multidisciplinary team meetings; in particular their influence on patient management. To evaluate the influence of radiologists on clinical patient management during multidisciplinary meetings.

Radiological Imaging in Trauma and Sports Injuries: Current Status and Limitations

Most acute traumatic and sporting injuries are clinically obvious or only require plain film imaging. In a minority of cases, more sophisticated imaging is required in the acute setting. MRI has revolutionised the imaging of both acute and chronic trauma of soft tissues and bone. It has provided an avenue for surgical planning and the exclusion of occult injuries. However, a well-planned approach is necessary to get the best out of MRI, with important decisions regarding arthrography and type of sequences that is optimal. Ultrasound is a good alternative in many instances but is limited by local expertise and experience and is operator dependant. CT has well-defined uses but is limited by the radiation doses, especially in the paediatric setting. There are a number of instances in which special care is required in imaging of trauma, especially with reference to child abuse. A team approach to imaging of athletic injuries is mandatory, especially in imaging of elite athletes.