N T Griscom

Bronchogenic Cysts of the Mediastinum in Infancy

Abstract Of 10 infants with mediastinal bronchogenic cysts seven were in severe or moderate respiratory distress at admission. In none was the precise diagnosis of bronchogenic cyst made before operation. In four, including all three fatal ones, the presence of a mediastinal mass was not even recognized. Seven of the eight infants operated upon survived and were alive and well up to 20 years later. Two infants died without surgery. Variable clinical and radiographic findings of bronchogenic cysts of the mediastinum may obscure diagnosis and delay treatment. Chest films may show severe hyperaeration, areas of collapse, atelectasis of an entire lung, or a mediastinal mass. Complete obstruction of a bronchus in utero can lead to retention of fetal fluid within the lung, which may be mistaken for a pulmonary tumor.

Computed tomographic determination of tracheal dimensions in children and adolescents.

A computed tomographic system for determining the internal diameters, cross-sectional area, and length of the trachea in children and adolescents was developed. Intraluminal volumes were calculated from these measurements.The results of 18 analyses are reported.

Intrauterine fetal transfusion in 365 fetuses during fifteen years

Abstract The results of intrauterine fetal transfusion in 365 consecutive fetuses with erythroblastosis fetalis, between May 1 1964, and December 1979, are reported. The gestational ages of the fetuses at initial transfusion ranged from 22 to 33 weeks. The criteria for transfusion were established by optical density measurements on amniotic fluid supplemented by amniograms and ultrasonography. The transfusions were performed under x-ray and fluoroscopic guidance in the first 330 fetuses and 142 survived (43%). Two hundred fifty-eight of these had no evidence of ascites or hydrops initially and 137 survived (53%). Of the 72 fetuses which had hydrops or ascites, five survived. For the last 35 fetuses treated since January 1978, the procedure has been performed under direct ultrasound guidance with the use of a real-time phased array sector scanner. Seventeen fetuses have survived (49%). Twenty-one of the 35 fetuses had no evidence of ascites or hydrops and 13 survived (62%). Of the 14 fetuses who had hydrops or ascites, four survived.

Radiation Therapy of Inoperable Breast Carcinoma

Radical mastectomy is generally accepted as the most effective means of eradicating early carcinoma of the breast. When cases are selected according to Haagensens clinical and biopsy criteria of operability (1, 2), and when the operation is performed according to the technic of Halsted, a fairly satisfactory percentage of patients can be cured with reasonably low operative morbidity and mortality. For a significant number of breast carcinomas, however, radical mastectomy can do little. In some instances the disease has progressed too far, either locally or by distant metastasis. In others, serious systemic conditions prohibit curative surgery. Some patients have so-called inflammatory carcinoma (3), which reacts quite unfavorably to operation (4, 5). All of these cases must be managed by other means—radiotherapeutic, chemotherapeutic, hormonal, or some combination of these. It is with the experience of The Massachusetts General Hospital with radiation therapy of inoperable carcinoma of the breast that th...

Inflammatory carcinoma of the breast: Results following orthovoltage and supervoltage radiation therapy

Summary The radiotherapeutic management of thirty-three cases of inflammatory carcinoma of the breast seen at the Massachusetts General Hospital from 1944 through 1959 has been reviewed. Sixty-five per cent of the patients treated by irradiation of the breast without concurrent alteration of the hormonal substrate showed definite favourable local responses lasting 4 months or more, the average favourable response lasting 27·5 months. Sixty-nine per cent of the patients treated with concurrent alteration of the hormonal substrate showed similar favourable responses, lasting an average of 16 months.

Pneumonia in children and some of its variants.

Pneumonia is still a major threat to the health of children. Carefully planned, meticulously performed, and thoughtfully analyzed chest radiography--occasionally supplemented by fluoroscopy, esophagography, computed tomography, and other studies--remains radiologys chief contribution to the control of this illness.

Cross-sectional shape of the child's trachea by computed tomography

Computed tomographic scanning was used to investigate the shape in cross section of the lumen of the pediatric trachea. Seven children up to age 10 (mostly age 6 or older), six girls aged 10-19, and six boys aged 10-19 had scans of their tracheas, mostly during breath-holding not far from total lung capacity. At these ages and under these circumstances, the trachea may be slightly narrow just below the larynx, and it broadens just above its bifurcation. At other levels, it is only mildly or moderately off-circular although there are variations from patient to patient and from level to level. The severely off-circular shapes found by others during autopsies and computed tomography of the middle-aged and elderly were not detected in these children and adolescents. Under the circumstances of the study, there was little change in shape or size as the trachea passed from the neck into the chest, nor was there a consistent difference in tracheal shape between girls and boys.

A further look at the total body opacification effect

Abstract Total body opacification is the radiological phenomenon in which, after intravenous injection, contrast agent opacifies the structures of the body in proportion to their blood supply. Avascular lesions can thus be rendered radiologically visible as lucencies newly contrasting with surrounding opacified structures. Appreciation of the total body opacification effect is widely useful in diagnostic radiology, especially in the delineation and characterization of neonatal abdominal masses.

Caldwell Lecture. Respiratory problems of early life now allowing survival into adulthood: concepts for radiologists.

Many patients with illnesses that once were fatal at birth or during childhood now survive into adult life. This article considers four respiratory illnesses of early life in which long-term survival now occurs frequently: cystic fibrosis, diaphragmatic hernia, esophageal atresia-tracheoesophageal fistula, and bronchopulmonary dysplasia. In cystic fibrosis, although the median age at death is now 25 years, chronic pulmonary infection due ultimately to the abnormal composition and clearance of airway mucus is still the usual cause of death. Earlier survivors of congenital diaphragmatic hernia had only minor diminution of perfusion and ventilation of the lung on the side of the hernia as adolescents or young adults; however, as infants with greater degrees of pulmonary hypoplasia have successful repair of their hernias, more long-term respiratory impairment will probably be found. The esophageal atresia tracheoesophageal fistula complex leaves all esophagi and many tracheas permanently abnormal; recurrent aspiration, repeated pneumonia, and an unduly collapsible trachea are the result, although symptoms may be few. Survivors of bronchopulmonary dysplasia have decreased exercise capacity, wheezing, and recurrent pneumonia, although their chest radiographs may become normal or almost normal.

The trachea and esophagus after repair of esophageal atresia and distal fistula: Computed tomographic observations

Five patients, whose espphageal atresia and distal tracheoesophageal fistula had been repaired in infancy, were examined by computed tomography at age 2 to 21 because of recurrent or persistent tracheal or esophageal problems. Their tracheas generally failed to have the roughly circular cross-sectional shape found in controls. The pars membranacea was often unusually broad, with much more section-to-section variation in area than in controls. Change in cross-sectional area with respiratory phase, in the one patient assessed, was much greater than in a control. These tracheal abnormalities help to explain the tracheal symptoms found in these and simular patients. Their esophagi contained much air and fluid.