Paddy Taber

Use of MRI in evaluation of anorectal anomalies

Congenital anorectal anomalies present with a wide spectrum of anatomical deformity. The level of atresia, the extent of the development of the pelvic musculature, and the presence of associated anomalies all greatly influence treatment options. Further complexity may be introduced by previous attempts at correction. Magnetic resonance imaging (MRI) recently has been suggested as an effective tool in evaluation of such patients for surgical repair. Thirteen patients undergoing evaluation for either primary or secondary operations for imperforate anus were studied with MRI. Age range was newborn to 26 years. These patients had anorectal deformities in various stages of treatment--from newly diagnosed imperforate anus in the newborn to patients who had undergone previous surgical repair of their deformity with poor results. In newborns, MRI was very useful in assessing the level of atresia and determining whether perineal repair was advisable. In older patients with high atresias, MRI was useful in planning operative strategy and predicting the outcome by providing information about the pelvic musculature. This information was directly related to the size of the patient, ie, the larger, and therefore the older the patient, the more detail MRI provided about the pelvic musculature. Especially in secondary cases, this information proved to be helpful in determining the cause of the initial failure, ie, lack of adequate pelvic musculature or poor placement of the distal colon in relation to the striated muscle complex at the initial operation. MRI demonstrated previous unsuspected lesions such as tethered cord, sacral deformity or urinary tract abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital metastatic cervical teratoma: diagnostic and management considerations.

Cervical teratomas in the newborn are uncommon and difficult management problems, as their natural history and prognosis are not well defined. Existing or potential airway obstruction is usually the main concern in acute management of these patients. Total excision is essential to avoid local recurrence in benign lesions, and a small but present risk of malignancy can result in death from metastatic lesions which appear later. A unique case of neonatal malignant cervical teratoma with large congenital metastatic lesions present in liver, lung, and buttocks was successfully managed. Magnetic resonance imaging (MRI) was invaluable, both in delineating these lesions and in planning a four-stage curative resection of all macroscopic disease. Such a case has not been reported previously.

Effective thrombolytic therapy of aortic thrombosis in the small premature infant

Aortic thrombosis in the very-low-birthweight premature infant has remained both a diagnostic and a therapeutic dilemma. Nine small infants were evaluated for symptoms of extremity and/or visceral ischemia. All were found to have aortoiliac thrombosis most likely related to indwelling umbilical artery catheters. Diagnostic and therapeutic options were evaluated. An angiogram obtained through the catheter was found to be the most effective diagnostic technique. Local infusion of intra-arterial streptokinase (50 U/kg/h) directly into the clot for 36 hours resulted in resolution of ischemic symptoms. No complications were encountered with the use of this protocol.

Use of magnetic resonance imaging in planning the separation of omphalopagus conjoined twins

Magnetic resonance imaging (MRI) was used for the first time in the preoperative planning for separation of conjoined twins. In these omphalopagus infants, MRI showed normal biliary and cardiovascular structures and demonstrated, in detail, a relatively avascular plane through the liver bridge, which enabled safe separation with minimal blood loss at 3 1/2 months of age. A single MRI study supplied information superior to that obtained with multiple previously available imaging studies. MRI should be an essential part of the preoperative workup of all types of conjoined twins.

Chronic thallium poisoning: Rapid diagnosis and treatment

Summary A case of thallotoxicosis in a 3-year-old, white male is reported. A rapid laboratory test for thallium is described which has not previously been published in the pediatric literature. A rational plan of therapy is suggested which consists of cystine, methionine, and potassium chloride. Dithisone, though potentially hazardous, may also be used.

The management of tension pneumothorax in the neonate using the Heimlich flutter valve

TENSION PNEUMOTHORAX is a common complication of the newborn infant who requires resuscitation, assisted ventilation, or the use of continuous positive or negative airway pressure. Often it is a complication of the meconium aspiration syndrome; it also occurs spontaneously. Usually, tension pneumothorax causes sudden deterioration in the patients cardiopulmonary

Malposition of Umbilical Vascular Catheters in the Diagnosis of Congenital Diaphragmatic Hernia

Three cases of neonatal respiratory distress are presented to illustrate that congenital diaphragmatic hernia can be diagnosed on a chest-abdominal radiograph in which malposition of umbilical vascular catheters are demonstrated even before gas-filled loops of intestine become evident on the chest film.