Significance of radiographic findings in early-onset group B streptococcal infection.

Chest radiographs on 73 neonates with early-onset group B Streptococcus (GBS) infection were reviewed. Eighty-six percent of the infants were premature (less than 38 weeks); 68% weighed less than or equal to 1,500 g. In infants weighing less than or equal to 1,500 g, the predominant radiographic pattern was hyaline membrane disease (HMD) (80%). There was a significant increase in radiographic HMD in 1,000 to 1,500-g neonates with GBS infection (77%) when compared to a control group of infants without GBS infection (44%). Mortality in 1,000 to 1,500-g infants with GBS infection and radiographic HMD (95%) was also significantly higher than in the control group of infants with hmd HMD and no GBS infection (38%). In larger premature and full-term infants, the radiographic findings were not specific and also were not helpful in distinguishing GBS infection from other newborn respiratory disorders.

Fatal tuberculosis in young children.

Three young children with advanced cavitary pulmonary tuberculosis died between 1974 and 1978. Two of the patients had tuberculous meningitis as well. All diagnoses were verified at autopsy; however, all tuberculin skin tests were negative. These instances emphasize the difficulty of establishing the diagnosis of tuberculosis in young children. Tuberculosis should be considered in the differential diagnosis of cavitary chest disease in young children, even those with negative tuberculin skin tests.

Unilateral absence of a pulmonary artery.

Congenital absence of a main pulmonary artery is a rare anomaly. Most patients without associated congenital cardiac abnormalities are asymptomatic, and the diagnosis is first suggested by the appearance of the involved lung on a routine chest roentgenogram. The ipsilateral lung will be smaller than normal, and the contralateral lung will be overinflated and may herniate across the midline. We describe eight children with unilateral pulmonary arterial atresia (seven on the right side, four of whom were without associated cardiac anomalies).

Long-term follow-up of the Palmaz stent for iliac occlusive disease.

BACKGROUND: Thirty-eight limbs with iliac occlusive disease were treated with Palmaz stents from 1987 through 1991. METHODS: Indications for stent utilization included dissection induced by percutaneous transluminal balloon angioplasty (PTA) (10), restenosis after PTA (nine), post-PTA residual stenosis (nine), multiple stenoses or occlusion (five), and unfavorable location (five). RESULTS: The ankle/brachial pressure index increased from 0.53 +/- 0.27 to 0.8 +/- 0.26 after stent deployment. The intraluminal pressure gradient decreased from 31.9 +/- 16.3 to 0.9 +/- 2.2 mm Hg after stent deployment. Complications included pseudoaneurysm (one), arteriovenous fistula (one), iliac perforation (one), groin hematoma (two), and occlusion (two). Follow-up arteriogram showed stenosis proximal or distal (n = 4) or within the stents (n = 4). These were treated with PTA or stents. Two patients required an aortobifemoral graft. Nine patients have died. Life table analysis showed a 1-, 3-, and 5-year primary and secondary cumulative patency of 87% +/- 5.9%, 74% +/- 8.2%, and 63% +/- 10% and 91% +/- 5.1%, 91% +/- 5.6%, and 86% +/- 7.6%, respectively. CONCLUSIONS: Palmaz stents, often required to salvage a PTA failure, appear to maintain overall patency at a high level. However, intimal hyperplasia and the progression of atherosclerotic disease may result in a need for additional procedures to obtain this favorable outcome.

Indications for breast imaging in women under age 35 years.

To determine appropriate indications for breast imaging in young women, the authors correlated patient histories with mammographic and/or sonographic findings and biopsy or follow-up results for 625 patients aged 13-34 years. The only important indications were a palpable mass and suspicion of an abscess. Of the 335 studies performed for evaluation of a palpable mass, 184 (55%) were normal, 28 (8%) were compatible with benign disease, and 123 (37%) were suggestive of malignancy. Biopsies were performed in 73 patients; the findings were benign in 67 cases, and carcinoma was found in six. Imaging studies were considered helpful in four of the 15 cases of suspected abscess, in that the studies established the presence and extent of an abscess. Studies in 275 women were performed for a variety of other indications. The findings were normal in 239 (87%) studies, benign in 21 (8%), and suggestive of malignancy in 15 (5%); there were no known carcinomas in any of the patients. Women with the "low-yield" indications identified in this study should be followed up clinically rather than referred for imaging studies.

Pneumatoceles as a complication of chemical pneumonia after hydrocarbon ingestion.

Of 338 children with hydrocarbon ingestion, 134 (40 percent) had pneumonia. Pneumonia was most common after kerosene, furniture polish and lighter fluid ingestion. The pneumonia was most severe, however, with furniture polish. Pneumatoceles occurred in 14 children, most commonly with charcoal lighter fluid ingestion. Pneumatoceles generally appeared late, after the consolidation had cleared. Pneumatoceles were often large, septate and irregular, and sometimes contained fluid levels.

Acute Haemophilus pneumonia in childhood.

In our hospital Haemophilus influenzae type B seems to be a common cause of acute childhood pneumonia. In the past five years, 34 children with acute Haemophilus pneumonia were identified. Although these children generally had an uncomplicated segmental pneumonia associated with a bacteremia, 13 of the children had pneumonia with a pleural effusion. These children with Haemophilus pneumonia represented 18% of the children hospitalized with systemic Haemophilus disease and almost a third of those hospitalized with acute bacterial pneumonia from whom the causal agent was isolated.

Caffey's disease: a case originating in the first metatarsal and review of a 12 year experience.

This paper describes an infant with Caffey's disease who presented with swelling of the first metatarsal shown as hyperostosis histologically. He then developed scapular sclerosis and new bone formation. The mandible became involved 26 days after onset. A review of a 12 year experience with Caffey's disease (33 patients) disclosed a definite decrease in the number and percentage of patients seen since 1968.

The frequency of radiolucencies underlying cephalohematomas.

The authors studied skull radiographs of 66 infants with cephalohematoma. Twenty-three (35%) had radiolucencies in the skull; most of the radiolucent defects were associated with beginning or extensive ossification over the cephalohematoma. Radiolucency associated with cephalohematoma is a frequent finding and rarely indicates local infection.

Facial bone infarcts in sickle cell syndromes.

Bone infarction in the sickle cell syndromes (sickle cell anemia, sickle beta thalassemia, and sickle C disease) is common in the long bones, but the facial bones, particularly the orbits, are infrequently involved. In a review of the literature, only 13 cases of facial bone infarcts in sickle cell syndromes were found. Seven episodes of facial bone infarcts--four orbital, two mandibular, and one in the zygomatic arch--in six patients encountered at the authors' institution are reported. Five patients had hemoglobin SS, and one had hemoglobin SC. Bone marrow scans were positive for infarction in five of the six episodes during which they were obtained, which highlights the usefulness of this technique in the diagnosis of facial bone infarction.

Papillary necrosis in a child with homozygous sickle-cell anemia.

A 4 1/2-year-old girl with S-S sickle-cell anemia was found to have papillary necrosis on excretory urography. This is believed to be the first reported case of papillary necrosis in a child with homozygous S-S sickle-cell anemia.

Congenital syphilitic osteitis of scapulae and ribs.

A newborn with congenital syphilis presented radiographically with a lack of ossification of the medial portions of several ribs and massive sclerosis and decalcification of scapulae. The uniqueness of syphilitic scapular and rib involvement is discussed. The infant also went on to develop skin lesions which appeared following penicillin therapy and also developed an extrahepatic biliary atresia.

Organizing hematoma in a child presenting as a 'doughnut lesion' on nuclear scan. Case report.

We report a 4 1/2-year-old boy who presented with a 4-week history of frontal headaches and fever, and generalized convulsion 5 months previously. Papilledema, an abnormal EEG and a brain scan with a frontal mass and 'doughnut' sign were found. The association of the clinical history with brain scan findings strongly suggested a brain abscess. At surgery the lesion proved to be an encapsulated hematoma; Histological findings suggest underlying microangiomata.

Congenital syphilis with syphilitic arthritis. Radiological quiz.

The authors report a case of congenital syphilis with involvement of a joint space and adjacent bony surfaces in a newborn infant. Although similar findings have been reported in older children, this appears to be the first such case in a newborn.