John W. Hope

The early recognition of premature cranial synostosis.

The characteristic roentgen findings in a child with a fully developed craniostenosis are known to most radiologists. These older children have misshapen heads and various neurological disorders, and the roentgenographic picture is typi cal. For example, closure of all the sutures gives rise to oxycephaly. Such a case is shown in Figure 1. The patient was a female of two and one-half years who was admitted because of a peculiarly shaped skull and a severe exophthalmos. Her vision was already impaired, and she was mentally retarded. The roentgenograms reveal closure of all the sutures. The skull has a turricephalic contour, indicating that the region of the anterior fontanel was probably the last to close. The digital markings are increased; the floor of the middle fossa is depressed and bulges forward. Another fully developed case of premature cranial synostosis is shown in Figure 2. This patient was a three-year-old female who also had a peculiarly shaped skull. At the time of admission her mentality was...

Cerebrospinal fluid otorrhea and recurrent meningitis

Summary This is the report of an unusual case of a child in whom otitic meningitis recurred twenty times. Four surgical procedures were required before the route of infection was finally detected and obliterated. Bacteriologic studies of the pathogens in the upper respiratory tract did not necessarily show correlation with organisms isolated on the culture of the cerebrospinal fluid. Laminagraphy is essential in searching for a possible fracture of the skull as the path of cerebrospinal fluid otorrhea. If the site of leak into the ear is not determined preoperatively, a radical mastoidectomy is essential to visualize the entire middle ear and the Eustachian tube. Dye should be injected into the cerebrospinal fluid at the time of operation.

Hydronephrosis Following Retrograde Pyeloqraphy1

“The Pelvocalyceal collecting systems are poorly visualized; advise a retrograde pyelogram.” This is a common recommendation following intravenous urography in many departments of radiology. Prior to the present study, the authors, using the renal clearance technic, had found that ureteral catheterization disturbed kidney function (1). In unilateral catheterization a greater volume of urine is formed by the catheterized kidney, but solute excretion by the two kidneys is essentially equal. When a wire stylet is required for insertion of the catheter, this difference in simultaneously formed urine by the two kidneys is exaggerated. Accordingly, ureteral trauma provokes an increase in water excretion: the greater the trauma, the larger the volume of water excreted. It occurred to us that these physiological observations might be reproduced more graphically with radiological studies. Method of Study With the above problem in mind, the authors selected 14 children for intravenous urography, to be followed by r...

Use of Air as a Contrast Medium in the Diagnosis of Intestinal Obstruction of the Newborn

Obstruction of the upper gastrointestinal tract in the newborn infant is a surgical emergency requiring immediate operative intervention. The earlier the diagnosis is made in these babies, the better is their chance of survival. Often they have but a single abnormality, and, following correction, will grow to be normal children. It is therefore essential that a diagnosis be made before they are literally worn out by dehydration and hunger. At The Childrens Hospital of Philadelphia the vast majority of these infants arrive as diagnostic problems, in spite of repeated roentgen examination. It is almost routine for them to be brought in with either the upper or the lower bowel full of some type of opaque contrast medium; often the entire bowel has been insulted from either end. It is not the purpose of this paper to criticize any particular type of opaque contrast medium, but to condemn unnecessary radiologic procedures which not only delay but often obscure the diagnosis. The Radiation Exposure Problem Rad...

The Use of Carbonated Beverages in Pediatric Excretory Urography

Intravenous urography is an important diagnostic procedure in pediatric radiology, but there are two factors which make this examination a difficult problem: first, the large amount of gas and feces present in the gastrointestinal tract; second, the low specific gravity of the urine in infants, preventing concentration of the contrast medium and resulting in poor visualization of the pelvo-calyceal collecting system. Before the advent of the method to be described, we were often guilty either of calling for a repetition of the examination or concluding merely that it showed no gross abnormalities but that fine detail of the pelvo-calyceal collecting system could not be visualized. Pediatricians in the Philadelphia area often hesitated to order an intravenous urogram because so frequently no diagnosis could be made. Cathartics will usually clean out the fecal material from babies and children, but the amount of gas generally increases, thereby aggravating the problem. Propping the child in the upright posi...

The Significance of Postoperative Pneumoperitoneum in Infants and Children

Postoperative pneumoperitoneum is a normal finding in the adult. References to free air left behind in the peritoneal cavity of these older patients following laparotomy (1, 2, 3) occur in the literature, but the authors have been unable to find any mention of this problem with specific reference to infants and children. It is generally agreed that air in the peritoneal cavity of an adult following laparotomy will persist for seven to fourteen days, and it has been reported as late as twenty-three days. It was in 1952 that the problem was first encountered in an infant by one of the authors. An eight-day-old male infant was transferred to the Childrens Hospital of Philadelphia because of vomiting bloody, bile-stained fluid since birth. On admission, the baby was extremely dehydrated and almost dead. Roentgen examination of the abdomen (Fig. 1) revealed a mechanical obstruction of the small bowel, most probably in the ileum. Laparotomy confirmed the roentgen finding of obstruction due to an ileal atresia ...

Pyloric stenosis: Postoperative roentgen studies and their clinical significance

Summary Twenty infants were studied radiographically following successful pyloromyotomy for hypertrophic pyloric stenosis. Although the gastric emptying time was improved, all showed persistent narrowing of the pyloric canal. Since the postoperative roentgen appearance may not differ appreciably from the preoperative appearance, the decision to perform a second pyloromyotomy should never be based on roentgen findings alone.

Voiding urethrography: an integral part of intravenous urography

Summary 1. The value of including a voiding urethrogram as a routine procedure during intravenous urography has been discussed. 2. Four cases illustrative of urethral lesions which could be corrected by operation have been presented. 3. Two of these 4 are, to our knowledge, the first cases of anterior urethral valves demonstrated in the United States.

An extra-adrenal pheochromocytoma in a child.

Pheochromocytomas in the adult are sufficiently common that an individual case report would not be of particular value. In the pediatric age group, however, they are of less frequent occurrence. Indeed, in the 105 years existence of The Childrens Hospital of Philadelphia, this is our only example. To publish a case solely because of its rarity is not necessarily a sound justification. This particularpheo-chromocytoma arose from a site other than the adrenal region, and because of this we feel its teaching value makes it worthy of being reported. Until relatively recent years, both the neuroblastoma and the pheochromocytoma were thought of as arising only in the suprarenal region. It is true that the majority of neuroblastomas and pheochromocytomas have their origin in the adrenal region, but they may be found anywhere along the sympathetic chain. In the case to be reported the tumor arose at the level of the hilus of the left kidney. Case Report A 7 1/2-year-old white boy was admitted to The Childrens H...

ROBERT P. BARDEN, M.D., PRESIDENT OF THE RADIOLOGICAL SOCIETY OF NORTH AMERICA.

“Be simple in concept, terse in expression, and logical in progress from one idea to the next” (1). Your incoming Presidents self-revealing words illuminate some of the outstanding characteristics of this distinguished clinician, teacher, and medical statesman. Robert Phelps Barden was born in New York in 1906, there attended the Horace Mann School for Boys, and was graduated from Princeton in 1929. While junior at Princeton, Bobs father died, and his mother, with a fine musical back-ground from Oberlin, entered the public school system of New York City at the age of fifty. While helping Bob to continue his education, along with Bobs brother and sister, Mrs. Barden became Director of the Music Department at Erasmus Hall High School, a significant achievement. Bob returned to New York to take his degree in medicine at Columbia University in 1933. Presented with opportunities for graduate study in Michigan, Boston, and Philadelphia, he chose the latter because of its reputation and proximity to home. Dr....“Be simple in concept, terse in expression, and logical in progress from one idea to the next” (1). Your incoming Presidents self-revealing words illuminate some of the outstanding characteristics of this distinguished clinician, teacher, and medical statesman. Robert Phelps Barden was born in New York in 1906, there attended the Horace Mann School for Boys, and was graduated from Princeton in 1929. While junior at Princeton, Bobs father died, and his mother, with a fine musical back-ground from Oberlin, entered the public school system of New York City at the age of fifty. While helping Bob to continue his education, along with Bobs brother and sister, Mrs. Barden became Director of the Music Department at Erasmus Hall High School, a significant achievement. Bob returned to New York to take his degree in medicine at Columbia University in 1933. Presented with opportunities for graduate study in Michigan, Boston, and Philadelphia, he chose the latter because of its reputation and proximity to home. Dr....