Sara J. Abramson

Cervical neuroblastoma in eleven infants: a tumor with favorable prognosis: clinical and radiologic (US, CT, MRI) findings

Cervical neuroblastoma, a disease primarily of infants, has a favorable prognosis. Eleven patients are reported. Clinical presentations (other than mass) included stridor and swallowing problems. Masses when felt were commonly mistaken for infectious adenitis. Imaging studies (US, CT, MRI) showed solid masses with vascular displacement and narrowing; intraspinal extension was absent though extension into the adjacent sites of mediastinum and skull occurred. Horner syndrome was seen in five patients with accompanying heterochromia iridis in one. Five tumors had calcification. A high index of suspicion will lead to biopsy and less delay in diagnosis once a mass is felt or imaged.

Neuroimaging of brain injury in neonates treated with extracorporeal membrane oxygenation: Lessons learned from serial examinations

The head ultrasound (US) is used extensively at most extracorporeal membrane oxygenation (ECMO) centers to screen for intracranial pathology in the ECMO candidate. Daily head US examinations are obtained in patients on ECMO to detect the emergence of intracranial hemorrhage (ICH). The authors asked whether these serial studies could be correlated with more definitive diagnostic studies, such as computed tomography (CT) and magnetic resonance imaging (MRI) scans, autopsy data, or the long-term neurodevelopmental status, to discern the predictive value of these daily examinations. Seventy-four consecutively treated neonates with reversible respiratory failure refractory to conventional support met institutional criteria for placement on ECMO. In addition to a pre-ECMO US, daily real-time portable head US images were evaluated for changes in echotexture, ventricular configuration, and extraaxial fluid. Follow-up CT and MRI scans were evaluated for the presence of hemorrhagic or ischemic lesions. Autopsy data were obtained from nonsurvivors. Survivors were examined by a neurodevelopmental specialist at regular intervals and classified as normal or delayed for chronological age. In this series of 74 patients, CT/MRI scanning and autopsy data demonstrated structural injury in 19 patients; there were 16 ischemic infarctions and three hemorrhages. The incidence of hemorrhage in this series was considerably lower than that previously reported. Ten of the 19 patients had serial head US findings demonstrating a progression from focal increases in echotexture to diffuse effacement of cerebral architecture. In the remaining nine, serial head US examinations did not show injury. An additional 10 children had a clear delay in neurological development despite no evidence of anatomic injury on serial head US examinations or CT/MRI scanning.(ABSTRACT TRUNCATED AT 250 WORDS)

Potential errors in the diagnosis and surgical management of neonatal jaundice

Despite advances and refinements in diagnostic techniques, distinguishing between cholestatic syndromes and extrahepatic biliary atresia is not always possible. Because there are inherent errors in all diagnostic studies including nuclear scanning, ultrasonography, and liver biopsy some infants presumed to have biliary atresia will come to surgery when, in fact, the bile ducts are partially or completely patent. The decision to proceed with a portoenterostomy or to terminate the procedure depends upon the appearance of the liver and histology of the biopsy.

Testicular-sparing surgery for benign testicular tumors.

BACKGROUND/PURPOSEnAlthough there has been a precedent of testicular-sparing surgery in some centers, the authors find it is still not general practice among pediatric surgeons. To address this and emphasize the role of testicular-sparing surgery in children, four patients with testicular masses are presented who underwent this procedure.nnnMETHODSnFour patients who underwent testicular-sparing surgery between the years 1993 and 1998 were reviewed. Demographic data, histopathology, and follow-up data were obtained from office charts. The period of follow-up ranged from 1 to 5 years.nnnRESULTSnFour patients whose ages at diagnosis were 1, 2, 4, and 17 years presented with unilateral testicular masses. The alpha-fetoprotein and beta-human chorionic gonadotropin levels were within normal limits. Testicular ultrasonography was carried out on all patients, and groin exploration with spermatic cord isolation was performed in each case. After enucleation, frozen sections to confirm benignity was carried out before repair of the testis. Follow-up of 6 months to 5 years has shown no recurrence, and on examination, testicular volume is normal in all cases.nnnCONCLUSIONSnTesticular-sparing surgery preserves testicular volume, which is important for both cosmetic and functional purposes. It is a viable and useful method in the management of benign testicular tumors in children.

Primary pulmonary tuberculosis in infancy: a resurgent disease in the urban United States.

Primary pulmonary tuberculosis in infancy still exists in the urban United States, reflecting new immigrations from less developed areas. The clinical diagnosis may be difficult and routine chest radiographs may be confusing. We found magnification high KV filtered radiography to be very useful in delineating lineating the primary complex and its effect on the tracheobronchial tree. Twelve infants and small children with primary pulmonary tuberculosis were seen in the years 1978–1984.

Postnatal resolution of large ovarian cysts detected in utero. Report of two cases.

Two cases of spontaneous resolution of large ovarian cysts in newborns are presented. In both cases the cysts were detected prenatally with ultrasound. In one case the cyst disappeared before birth; in the other, the cyst resolved several weeks postnatally. Both infants also displayed labial, uterine and vaginal enlargement, signs of maternal estrogen stimulation. These large ovarian cysts are also most likely under some hormonal stimulation and may undergo spontaneous resolution and therefore obviate the need for surgery.Two cases of spontaneous resolution of large ovarian cysts in newborns are presented. In both cases the cysts were detected prenatally with ultrasound. In one case the cyst disappeared before birth; in the other, the cyst resolved several weeks postnatally. Both infants also displayed labial, uterine and vaginal enlargement, signs of maternal estrogen stimulation. These large ovarian cysts are also most likely under some hormonal stimulation and may undergo spontaneous resolution and therefore obviate the need for surgery.

Retrocardiac pneumomediastinum in association with tracheal and esophageal perforations

Retrocardiac pneumomediastinum was encountered in two premature infants; one had a tracheal perforation and one an esophageal perforation. Contrast studies showed communication between the sites of perforation and the retrocardiac air. Clinical signs suggestive of such perforation include abnormal course of tubes on plain chest films and bloody aspirates.

Iatrogenic causes of large pleural fluid collections in the premature infant: ultrasonic and radiographic findings.

Ten cases of large pleural collections, all of which were iatrogenically induced in premature infants, are presented. There were five instances of hypopharyngeal tears communicating with the right pleural space, three of chylothorax secondary to superior vena caval obstruction in patients undergoing total parenteral nutrition catheterization (TPN), and two of direct erosion by the inferior vena caval TPN catheter into the pleural space. Ultrasonography was most helpful in detecting these pleural collections. It is important to recognize the presence of pleural fluid in these infants as a marker of iatrogenic injury.

Three pediatric patients with extension of prostatic embryonal rhabdomyosarcoma anterior to the bladder into the space of Retzius

Invasive embryonal rhabdomyosarcoma of the prostate often extends superiorly into the bladder base requiring partial cystectomy as part of excision of the primary tumor. Three patients were studied with ultrasonography CT and MRI and showed the extension of the tumor superiorly and anterior to the bladder in the prevesical space of Retzius. Complete excision with bladder sparing was successful in two of the patients. The imaging of pelvic tumors in children (although well studied with ultrasonography, CT) is helped by MRI in the sagittal plane and/or lateral films of intravenous pyelograms and cystograms to establish the relation of the tumor to the bladder.

Epiphyseal separation simulating pyarthrosis, secondary to copper deficiency, in an infant receiving total parenteral nutrition

In 1953 Baxter, Van Wyck and colleagues (Baxter & Van Wyck, 1953; Baxter et al, 1953) reported on a bone disorder in puppies fed a diet low in copper; the animals developed osteoporosis, fractures, epiphyseal separations. The bone changes had a striking resemblance to scurvy and healed completely with addition of copper to the animals feeds. In the next three decades, a small number of clinical reports were published recording a syndrome in infants of anaemia, bone disease and hypocupraemia. Some of the infants developed this on the basis of malnutrition (Sturgeon & Brubaker, 1956; Cordano et al, 1964; Ashkenazai et al, 1971; Kozlowski & Walker-Smith, 1973) while others were patients receiving long-term total parenteral nutrition (TPN) (Karpel & Peden, 1972; Heller et al, 1978). Griscom and colleagues (1971) recorded a systemic bone disease occurring in premature infants, with X-ray findings of osteoporosis, fractures and epiphyseal slippage, despite adequate vitamin intake. They referred to Baxter and V...