Rita L. Teele

The infant with possible biliary atresia: Evaluation by ultrasound and nuclear medicine

Twenty-eight infants with jaundice were evaluated with ultrasound and radionuclide scans. Comparison of these studies with pathologic, surgical and clinical examinations demonstrated good correlation between ultrasonic and radionuclide studies. Ultrasound is an important preliminary study in the workup of such patients. Combined imaging provides the most information in a patient with suspected biliary atresia.

Sclerosing encapsulating peritonitis associated with continuous ambulatory peritoneal dialysis: Surgical management

Sclerosis of the peritoneum with encapsulation of the small intestine is one of the most serious complications of continuous ambulatory peritoneal dialysis (CAPD) and is associated with a high mortality rate. Its presence should be suspected in patients treated by CAPD who develop small bowel dysfunction with associated abdominal pain and progressive loss of ultrafiltration. In its severest form, it leads to complete high small intestinal obstruction and requirement for total parenteral nutrition. We report the successful surgical management of two young, severely emaciated patients who had this complication of CAPD. Each had entrapment of their bowel by a thick, fibrosed, and calcified membrane. Both were treated by surgically peeling the membrane away from the intestines.

Septo-optic-dysplasia-schizencephaly. Radiographic and clinical features.

The anatomical anomalies that characterize septo-optic-dysplasia (deMorsier Syndrome) are variable and often subtle. We report imaging studies of nine patients with septo-optic-dysplasia which provide radiologic and ultrasonographic clues to this disorder. In addition, we propose that cerebral schizencephaly may be a component of the dysmorphogenesis that results in septo-optic-dysplasia. Septo-optic-dysplasia-schizencephaly complex is frequently associated with endocrinologic, ophthalmologic, and neurologic symptoms and signs.

Sonography of testicular microlithiasis.

The sonographic appearance of testicular microlithiasis detected in a patient presenting with torsion is described. A “speckled” pattern of multiple, tiny bright echoes is produced by calcific concretions in the seminiferous tubules and seems to be characteristic of microlithiasis. Although this condition is not treatable, it should be recognized because it is often associated with extratesticular abnormalities and can obscure superimposed testicular disease.

A normal sonogram does not exclude malrotation.

Abstract We present case reports of three recent patients to reinforce the argument that upper gastrointestinal series is the method of choice with which to document malrotation. It has been 9 years since there was a major discussion of this subject in the literature. Ultrasonography cannot confidently exclude malrotation. Radiographic study with contrast continues to be the best diagnostic tool.

Diaphragmatic movement in newborn infants

Axial movement of the right hemidiaphragm during tidal breathing was recorded using real-time ultrasonography in 46 healthy term infants. Displacement was 2.6 +/- 0.1, 3.6 +/- 0.2, and 4.5 +/- 0.2 mm (mean +/- SEM) for the anterior, middle, and posterior thirds, respectively. Diaphragmatic movement was significantly greater in the middle and posterior segments than in the anterior segment (P less than 0.0001). Excursion of the diaphragm was similar in sleeping and awake infants, and during quiet and active sleep, as identified by behavioral criteria. Diaphragmatic movement was also assessed in nine infants who required mechanical ventilation and pharmacologic paralysis because of respiratory disease. In these infants, axial movement of the right hemidiaphragm was less in the middle and posterior thirds (P less than 0.05 and P less than 0.01, respectively) than in spontaneously breathing infants, and posterior movement was not predominant. Normative data for axial diaphragmatic movement may be of clinical value in the assessment of defects of the diaphragm, rib cage, or abdomen in newborn infants and may allow further understanding of the direct effects of therapeutic interventions on the respiratory system in infancy.

Measurement of the subarachnoid space by ultrasound in preterm infants.

Background: Measurements of the subarachnoid space during routine cranial sonography may provide an indirect method of monitoring brain growth in preterm infants. Methods: The width of the subarachnoid space was measured on coronal views during head sonography. Initial scans (within five days of birth) were compared with follow up scans. Results: A total of 361 scans were performed on 201 preterm infants. The mean width of the subarachnoid space was < 3.5 mm for 95% of initial scans. It was slightly larger in neonates born closer to term, the equivalent of an increase of 0.02 mm/gestational week (95% confidence interval 0 to 0.10 mm) for initial scans. When the scans of all infants, born at 24–36 gestational weeks who were 36 weeks corrected gestational age were compared, the mean (SD) subarachnoid space was 60% larger for follow up scans than for intial scans: 3.2 (1.38) v 1.95 (1.35) mm (p = 0.002) or the equivalent of a mean increase of 0.20 mm/week (95% confidence interval 0.15 to 0.30 mm) for follow up scans. At 36 weeks corrected gestational age, mean head circumference was not different between those having initial or follow up scans (33.0 (2.0) v 32.2 (1.9) cm; p = 0.31). Conclusions: The mean subarachnoid space is normally < 3.5 mm in preterm infants. The difference between initial and follow up scans suggests reduced brain growth in extrauterine preterm babies.

The role of neonatal chest physiotherapy in preventing postextubation atelectasis

We retrospectively assessed atelectasis in 297 postextubation radiographs from 220 babies who underwent ventilation over a 2-year period. All 95 babies in the first year received peri-extubation chest physiotherapy; none of the 125 babies in the second year received chest physiotherapy. There was no difference in the incidence of postextubation atelectasis between the two groups.

Urolithiasis in a children’s hospital: 1985–1990

We performed a retrospective study of patients who had urinary tract stones and were seen at our hospital from 1985–1990. The study was intended to determine the prevalence of urolithiasis and optimal approaches to imaging. Clinical data and imaging studies of 87 patients were reviewed. The mean age was 15.7 years with a range of 3 months to 44 years. Fifty-four percent of patients were male. Most patients had a known predisposing cause for urolithiasis; patients with myelodysplasia and structural urologic problems predominated. Plain films were performed in 77 patients; 57% showed stones. Ultrasonograms were performed in 71 patients; 77% showed stones. Excretory urograms (EU) were performed in 49 patients; 84% showed either stones or their effect on the urinary tract. Computed tomographic (CT) scan was performed in 25 patients; all showed stones.

The screening pelvic radiograph in pediatric trauma

Background. Pelvic radiographs are routinely obtained in adult trauma to optimise early management. In adults, pelvic fractures are associated with high early transfusion requirement, high injury severity scores and an increased incidence of other abdominal and thoracic injuries. It is unclear whether this holds true in children. Objective. To determine whether the screening pelvic radiograph is necessary in paediatric trauma. Materials and methods. The notes of all patients who presented after trauma to the Starship Childrens Hospital and were triaged to the resuscitation room during 1997 were reviewed. Results of initial radiography were obtained and correlated with later imaging. Results. Our review of 444 injured children seen over a period of 1 year revealed that of 347 children who had screening pelvic radiographs, only 1 had a pelvic fracture. The fracture in this child was clinically apparent and required no specific treatment. Conclusions. The presence of a pelvic fracture is rare in injured children. By omitting screening pelvic radiographs there are potential benefits, including reduced radiation exposure to children and cost savings. Uninterpretable or abnormal clinical examination or haematuria requires further investigation, but routine screening for pelvic fracture is unnecessary.