Sequential bone mineral content in small preterm infants with and without fractures and rickets.

Seventy-four infants with birth weights 1009 +/- 28 grams and gestational age 28.6 +/- 0.3 weeks (M +/- SEM) were studied prospectively to test the hypotheses that bone mineral content (BMC) measured by photon absorptiometry, would be: (1) lower in very low birth weight (VLBW) infants with radiographic evidence of fractures and/or rickets (F/R), and (2) will continue to be lower over the first year when compared to VLBW infants without F/R. BMC and bone width (BW) of the distal one-third of left radius and ulna were measured at 5 weeks (n = 8), 14 weeks (n = 61), 26 weeks (n = 58), 40 weeks (n = 59), and 1 year (n = 52). Standardized radiographs of both forearms, and weight, length, and head circumference were also determined at each study age. Investigators and technicians involved in the photon absorptiometry measurements were unaware of the radiographic findings and vice versa. Twenty-three of 74 infants were found to have F/R. BMC of studied infants remained markedly below our previously determined range of "intrauterine bone mineralization," even at 26 weeks after birth. There was no significant difference in BMC or BW between infants with and without F/R, either at the time of confirmation of F/R or during early follow-up; however, BMC was lower at greater than or equal to 6 months and BW was lower at greater than or equal to 9 months in infants with F/R. We suggest that the extremely low BMC measurements in early infancy predispose all VLBW infants to fractures and rickets.

Pleural effusion: the thorn sign. Not a rare finding.

Eleven percent of an unselected series of 157 patients with pleural effusion showed a thorn-like protrusion of fluid at the lateral end of the minor fissure at some time during their illnesses. None of a series of 146 normal x-ray films of young patients showed this "thorn sign." The thorn sign is a useful radiographic finding of right-sided pleural effusion.

Vitamin D requirement in infants receiving parenteral nutrition.

The adequacy of low dose vitamin D (25 IU/dl) parenteral nutrition (PN) solution was studied in 18 infants. All infants had surgical indications for PN. The birth weights were 2810 +/- 135 g and gestational ages 37.4 +/- 0.5 wk (mean +/- SEM). Duration of study ranged from 5 to 175 days. Thirteen infants were studied for up to 6 weeks and five infants for 71 to 175 days. Results showed that studied infants maintained growth along normal percentiles for weight, length, and head circumference. Vitamin D status as indicated by serum 25 hydroxyvitamin D (25 OHD) rose from 15 +/- 1.9 ng/ml to 26 +/- 2.8 ng/ml, mean +/- SEM (p less than 0.001) after 9 days, and remained normal up to 6 months. Five infants with biochemical liver dysfunction also had normal serum 25 OHD concentrations, indicating the hepatic 25 hydroxylation process was not severely impaired. Serum total and ionized calcium, phosphorus, and vitamin D-binding protein concentrations were normal. Serum magnesium was mildly elevated in five infants (2.6 to 3 mg/dl) on one occasion and resolved spontaneously. Serum alkaline phosphatase (AP) concentrations rose above baseline values in 12 of 17 infants, but remained within normal range (less than 400 IU/liter at 30 degrees C). Another infant with markedly elevated AP values died from liver dysfunction. Radiographs of the forearms were normal except for marked demineralization in one infant in spite of normal 25 OHD concentrations. We conclude that 25 IU vitamin D/dl of nutrient infusate is adequate to maintain normal vitamin D status, as indicated by normal serum 25 OHD concentrations in infants receiving PN for as long as 6 months.

H. Binga Dismond, MD--pioneer Harlem physician and much more.

All physicians hopefully have some interests beyond their specialty. Dismond exemplified a broad range of activities, including athletics, military service, poetry, multiple marriages, and socializing, as well as two specialties in medicine.

A helpful hint for chest radiology: "look behind the heart".

Pathologic abnormalities on frontal chest radiographs are often located solely or partially in the retrocardiac region. It is essential to include a look behind the heart when viewing the frontal x-ray. Cases of pneumonia, metastases, and posterior mediastinal mass, all of which would have been missed without a look behind the heart, are used to illustrate this precept.

Pleural effusion in sickle cell disease.

Pneumococcal and mycoplasma infection of the lung or pleura, infarction of lung or pleura, local abscess below the diaphragm, and heart, kidney, or pancreas involvement are among the many causes of pleural effusion. Several of these have an increased likelihood of occurrence in sickle cell disease as a direct consequence of sicklemia or of the functional asplenia which develops. A patient is presented in whom many of these considerations arose.

Rickets as an unexpected x-ray finding.

Rickets, whether due to lack of proper nutrition or secondary to disease or medication, may be unexpectedly detected on radiographs obtained for other reasons. Several recent examples are reported here. It is important to be aware of the manifestations of rickets so that appropriate treatment is not delayed. Physicians should be alert for signs of rickets in the x-ray examination of any child.

Transient loss of femoral head Tc-99m diphosphonate uptake with prolonged maintenance of femoral head architecture.

Nine pediatric patients presented with synovitis and suspected Legg-Perthes disease, hemarthrosis, acute slipped capital femoral epiphysis, prolonged traumatic hip dislocation, or transcervical femoral fracture. All had hip scintigraphs that showed loss of Tc-99m diphosphonate uptake in the affected femoral head. Radiographic changes associated with aseptic necrosis failed to appear during the initial follow-up period of three to 14 months. Repeat scintigraphy showed complete revascularization in six cases and partial revascularization in two. Reambulation at 1.5 to eight months after presentation was accomplished without recurrence of pain in seven cases, without development of x-ray changes in 5 cases. Three children developed x-ray changes associated with avascular necrosis after reambulation, while one child had minimal x-ray changes. Some children with loss of uptake in the femoral head do not develop x-ray changes associated with aseptic necrosis.

The lateral clavicle hook-an acquired as well as a congenital anomaly.

The lateral clavicle hook (LCH), an excessive upward convexity of the lateral clavicle, was formally defined by Igual and Giedion, and reported as always present in thrombocytopenia-radial aplasia syndrome and sometimes in other congenital malformations. Additional malformation syndromes including camptomelia are added. In addition, the hook may be seen in acquired upper extremity weakness such as in persistent brachial plexus injury after birth trauma and in severe osteogenesis imperfecta.

[Rare acute disease pictures of the upper respiratory tract in children]. / Seltene akute Krankheitsbilder der oberen Atemwege bei Kindern.

The radiologist should recognize dangerous uncommon conditions such as epiglottitis and membranous croup by their pattern on conventional images. Subglottic narrowing, as from croup, is recognizable on lateral images by loss of the superior interface of trachea and vocal cords. A lateral image is important when an upper esophageal foreign body is seen on a frontal view.

Glen W. Hartman Lecture: Radiology Section of the National Medical Association. Centennial history of African-Americans in radiology.

It has not been an easy century for African-Americans in radiology, but many accomplishments have been achieved, often in the face of considerable adversity. Many, many important persons have been omitted from this essay. This section (Fig. 5) has supported progress through the years. May it continue the good work.

Radiologic history exhibit. 1934: fateful year in the history of African-Americans in radiology.

The year 1934, just over a third of the way into the first century of the x ray and of the NMA, reflected both successes and difficulties for the minority radiologist. African-Americans constituted disproportionately small numbers within the radiologic community (Fig 9), and few of them were on the AMA's approved list. Membership in major radiologic societies was lacking; many were excluded from applying for the new American Board of Radiology examination. On the other hand, the major radiology journals began to publish articles by African-American authors, a select few radiologists were on the AMA specialist list, and the first steps to board certification were appearing.