Lawrence A. Davis

The lower urinary tract in infants and children.

Urinary tract infection is extremely common and in pediatric practice such infections occurring repeatedly are generally considered an indication for excretory urography. In many instances, if the urogram is normal, the diagnosis is “cystitis” or “pyelonephritis,” and only medical measures are prescribed. A normal excretory urogram, however, does not exclude urinary tract obstruction, particularly in patients in whom serious damage has not resulted. “Pyelonephritis” is a diagnosis of exclusion in infancy and childhood, and until urinary tract obstruction has been ruled out by all possible means, the patient has not been adequately investigated (1, 2). Cystoscopy is relatively ineffective in evaluation of the posterior urethra and the bladder neck and a complete study of the urinary tract in patients with continuously infected urine must include a voiding cystourethrogram. This examination is the most efficient method of demonstrating obstructions in the bladder neck and urethra, and of analyzing the compe...

Pulmonary Artery Stenosis

Although the number of cases of stenosis of a branch or branches of the pulmonary artery reported in the literature is small, this congenital lesion is being recognized with increasing frequency. This report is a description of 2 cases seen within 1 year. Both cases were studied by means of cardiac catheterization and angiocardiography. In both there were complicating congenital heart lesions.

EFFECTS OF DIAGNOSTIC X RAYS ON CHROMOSOMES IN INFANTS: A PRELIMINARY REPORT.

It is now apparent that human cells are sensitive to irradiation both in vitro and in vivo. Since the initial reports of the mutagenic effect of ionizing radiation over three decades ago (1), a comprehensive literature with an increasing amount of data has accumulated showing that cells in tissue culture are extremely susceptible to x-ray damage (2–5). In the past several years, using the improved technics for chromosomal analysis in peripheral blood leukocytes, observations in vivo of chromosomal damage following both x-ray therapy and accidental whole-body radiation exposure have been made by several investigators (6–10). These chromosome abnormalities in peripheral leukocytes primarily involve chromosome breakage, followed by structural rearrangements and reunions. Such aberrations as dicentrics, fragments, and ring forms may persist as long as twenty years (9). However, reported studies of individuals receiving only the doses of x irradiation required in various diagnostic procedures have been limited...

COARCTATION OF THE AORTA ASSOCIATED WITH AORTIC STENOSIS AND A PATENT DUCTUS ARTERIOSUS.

Abstract A 14 year old girl with congenital aortic stenosis, coarctation of the aorta and patent ductus arteriosus is presented. Serial catheterization data demonstrated the relief of severe pulmonary hypertension after division of the patent ductus and resection of the coarctation. Further x-ray and electrocardiographic improvement followed open heart repair of the aortic stenosis. The response of the patient to the staged surgical approach as outlined was gratifying. A possible explanation of her improvement following the initial surgery is given.

Comparison of the Resting Gastric Secretion of Children and Adults

Examination of the gastric air bubble is a routine procedure preceding the actual introduction of opaque material into the stomach. A lengthened air-fluid interface, in the fasting patient, is generally believed to be a sign of increased gastric secretion. There is little information available as to the actual measurement of this interface in the available textbooks on gastrointestinal radiology or in the usual textbooks of gastroenterology. The apparent increase in the amount of gastric juice may be the result of enhanced secretion or possibly due to delayed emptying of the stomach secondary to an obstructive process. I have been unable, also, to find any reference to the amount of resting gastric secretion in children as related to its appearance in the routine upper gastrointestinal tract examination. Examination of children between five and ten years of age is common in the general pediatric x-ray department, since it is during this period that the complaint of abdominal pain is frequent. It was my im...

The Relationship of the Cardiac Silhouette to Altered Respiratory Dynamics in Congenital Heart Disease in Infants

The relationships of cardiac size and contour to respiratory dynamics in infants and the newborn who are suffering from the “bronchiolitic syndrome” are well known. Briefly, during the height of this inflammatory disease there are marked overventilation of the thorax with depression and flattening of the diaphragm, an increased anteroposterior thoracic diameter, bulging of the sternal plate anteriorly, and frequently widening of the rib interspaces. The cardiothoracic ratio during this period is markedly reduced, and there is actually a reduction in the overall roentgen size of the heart. There may also be changes in its configuration. If criteria for specific chamber enlargement depend either on the actual outline and configuration of the heart or upon its relation to the chest wall (1), these relationships are seriously disturbed merely because of change in the thoracic contour and not necessarily as a result of any intrinsic cardiac abnormality. These changes are well illustrated in Figure 1, A, which ...

The relation of the aortic root to the ventricular septum in tetralogy of fallot

Abstract Three cases of clinically classic tetralogy of Fallot are presented in which angiocardiographic studies demonstrated no overriding of the aorta. These studies indicate that many cases of tetralogy of Fallot should be considered as a type of ventricular septal defect with pulmonic stenosis, in which overriding of the aorta is of no functional or surgical importance.